Basic Information
| Provider Information | |||||||||
| NPI: | 1497048912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KACZKA-WEISS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 ROUTE 88 | ||||||||
| Address2: | FL 3 | ||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087243018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049887829 | ||||||||
| FaxNumber: | 5049884264 | ||||||||
| Practice Location | |||||||||
| Address1: | 1440 CANAL ST # TB52 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049887829 | ||||||||
| FaxNumber: | 5049884264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2011 | ||||||||
| LastUpdateDate: | 10/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0804X | DO.000320 | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.