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General NPI Number Information
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NPI Number | 1821451154
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Entity Type | Individual
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Provider Name | LAUREN RIDALL BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 229 LAUREL RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-1118
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Country | US
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Telephone | 631-659-3337
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Fax | 631-659-3338
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Provider Business Mailing Address
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Address Line | 229 LAUREL RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-1118
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Country | US
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Telephone | 631-659-3337
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Fax | 631-659-3338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-16-22105
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License Number State | NY
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