Provider Demographics
NPI:1053894030
Name:GEMBRY, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GEMBRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-0635
Mailing Address - Country:US
Mailing Address - Phone:098-332-3006
Mailing Address - Fax:
Practice Address - Street 1:540 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1532
Practice Address - Country:US
Practice Address - Phone:609-833-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2023-05-08
Deactivation Date:2018-10-08
Deactivation Code:
Reactivation Date:2021-06-10
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00266200101YA0400X
NJ37PC00767800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)