Provider Demographics
NPI:1720644941
Name:QUOCK, LAUREN MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:QUOCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 AMADOR VILLAGE CIR APT 12
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1281
Mailing Address - Country:US
Mailing Address - Phone:510-710-7050
Mailing Address - Fax:
Practice Address - Street 1:20200 REDWOOD RD STE 4
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4352
Practice Address - Country:US
Practice Address - Phone:510-710-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2024-12-06
Deactivation Date:2020-08-18
Deactivation Code:
Reactivation Date:2020-09-09
Provider Licenses
StateLicense IDTaxonomies
CA121483106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist