Healthcare Provider Details

I. General information

NPI: 1801127451
Provider Name (Legal Business Name): LAURA DENISE WHERRY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4726 NEW BROAD ST APT 305
ORLANDO FL
32814-6426
US

IV. Provider business mailing address

4726 NEW BROAD ST APT 305
ORLANDO FL
32814-6426
US

V. Phone/Fax

Practice location:
  • Phone: 407-280-0266
  • Fax: 407-852-3301
Mailing address:
  • Phone: 407-280-0266
  • Fax: 407-852-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1020873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: