Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY8571 | FL |
Y | 103TC0700X | Clinical Psychologist | PY8571 | FL |
NPI | 1003108077 |
---|---|
Provider Name | Dr. Lauren K. Grodin |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-5431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 15/03/2021 |