Provider Demographics
NPI:1962001982
Name:CERCONE, LAUREN ELIZABETH (LCDC II)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:CERCONE
Suffix:
Gender:F
Credentials:LCDC II
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC II
Mailing Address - Street 1:725 BOARDMAN CANFIELD RD STE C4
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4367
Mailing Address - Country:US
Mailing Address - Phone:855-292-9778
Mailing Address - Fax:
Practice Address - Street 1:725 BOARDMAN CANFIELD RD STE C4
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4367
Practice Address - Country:US
Practice Address - Phone:855-292-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161966101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)