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NPI Code Detail

MEDICARE: MRS. LAUREN MARJORIE LATHAM BCBA

MEDICARE: MRS. LAUREN MARJORIE LATHAM BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystFL
2247200000XOther Technician247200000FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336691146
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREN MARJORIE LATHAM BCBA
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 855-832-6727
Fax Number :
Provider Business Practice Location Address
First Line : 9160 FORUM CORPORATE PKWY STE 350
Second Line :
City : FORT MYERS
State : FL
Zip : 33905-7808
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2016
Last Update Date : 12/13/2021

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