Healthcare Provider Details

I. General information

NPI: 1700447760
Provider Name (Legal Business Name): CATHERINE ROSE LARK PHD, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 PERKINS RD STE 500
BATON ROUGE LA
70808-4278
US

IV. Provider business mailing address

2210 CHRISTIAN ST APT 12
BATON ROUGE LA
70808-2173
US

V. Phone/Fax

Practice location:
  • Phone: 225-368-2297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1523
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number394
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: