MEDICARE: LAUREN JANE CORCORAN BCBA, LABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134679889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN JANE CORCORAN BCBA, LABA

Provider Business Mailing Address
First Line	:	185 LINCOLN ST STE 205
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-1741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 LINCOLN ST STE 205
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-1741
Country	:	US
Telephone Number	:	781-749-3606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	12/20/2024

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