=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275490088
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN BISSETTE
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2026
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 ART MUSEUM DR
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-2151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-477-7568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 331 CLAREMONT DR
-----------------------------------------------------
City | YULEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32097-0182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-285-8489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------