MEDICARE: LANTERN LEARNING SOLUTIONS, LLC

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	:	1720627532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANTERN LEARNING SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	936 SW 1ST AVENUE
Second Line	:	#433
City	:	MIAMI
State	:	FL
Zip	:	33130-4520
Country	:	US
Telephone Number	:	805-252-7770
Fax Number	:	877-794-7404

Provider Business Practice Location Address
First Line	:	936 SW 1ST AVE # 433
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-4520
Country	:	US
Telephone Number	:	805-252-7770
Fax Number	:	877-794-7404

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	TANYA SCHWABE
Credential	:
Telephone Number	:	248-721-0405

Provider Enumeration Date	:	12/26/2019
Last Update Date	:	12/26/2019

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