Basic Information
| Provider Information | |||||||||
| NPI: | 1356668016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDRICK | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ROSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 GELLERT BLVD SUITE 280 | ||||||||
| Address2: | |||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159851393 | ||||||||
| FaxNumber: | 4158610257 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 GELLERT BLVD SUITE 280 | ||||||||
| Address2: | |||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159851393 | ||||||||
| FaxNumber: | 4158610257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2010 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 109020 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.