Provider Demographics
NPI:1902177322
Name:MARKHAM, LAUREN (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:GERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:55 WHITING ST STE 1A
Mailing Address - Street 2:PO BOX 857
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2262
Mailing Address - Country:US
Mailing Address - Phone:860-517-8557
Mailing Address - Fax:
Practice Address - Street 1:55 WHITING ST STE 1A
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2262
Practice Address - Country:US
Practice Address - Phone:860-517-8557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical