Healthcare Provider Details

I. General information

NPI: 1639897960
Provider Name (Legal Business Name): LAUREN LEVATO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10817 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3616
US

IV. Provider business mailing address

432 GRIS SKY LN
BRADENTON FL
34212-3606
US

V. Phone/Fax

Practice location:
  • Phone: 866-311-4617
  • Fax:
Mailing address:
  • Phone: 774-261-3041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT22231113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: