MEDICARE: MS. LAUREN WOOD BCABA, 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	BACB695417	VA
2	103K00000X	Behavior Analyst	0-23-14239	VA

General Provider Information

NPI Number	:	1760223093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN WOOD BCABA, LABA

Provider Business Mailing Address
First Line	:	21430 TIMBERLAKE RD # 325
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-7248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 PORTER ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3740
Country	:	US
Telephone Number	:	757-903-9539
Fax Number	:

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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