Provider Demographics
NPI:1588113369
Name:INCOGNITO, LAUREN (LMSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:INCOGNITO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1756
Mailing Address - Country:US
Mailing Address - Phone:860-967-7353
Mailing Address - Fax:
Practice Address - Street 1:33 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2022
Practice Address - Country:US
Practice Address - Phone:860-223-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker