1083916118 NPI number — LAUREN MICHELLE MANLOVE LCSW, CCM

Table of content: LAUREN MICHELLE MANLOVE LCSW, CCM (NPI 1083916118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083916118 NPI number — LAUREN MICHELLE MANLOVE LCSW, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANLOVE
Provider First Name:
LAUREN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARON
Provider Other First Name:
LAUREN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ASW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083916118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11622 EL CAMINO REAL STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92130-2051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-549-0329
Provider Business Mailing Address Fax Number:
619-550-3547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 MISSION AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92058-7102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-967-4475
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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