Healthcare Provider Details

I. General information

NPI: 1013648682
Provider Name (Legal Business Name): LAUREN MARIE PETERSEN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 HAWAII KAI DR APT L12
HONOLULU HI
96825-4128
US

IV. Provider business mailing address

7007 HAWAII KAI DR APT L12
HONOLULU HI
96825-4128
US

V. Phone/Fax

Practice location:
  • Phone: 573-760-2488
  • Fax:
Mailing address:
  • Phone: 573-760-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002566
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-1014
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: