MEDICARE: LAUREN BACOTTI BCBA

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	00412389	NJ

General Provider Information

NPI Number	:	1811542988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BACOTTI BCBA

Provider Business Mailing Address
First Line	:	155 WASHINGTON ST APT 1006
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4580
Country	:	US
Telephone Number	:	201-403-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 WASHINGTON ST APT 1006
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4580
Country	:	US
Telephone Number	:	201-403-5673
Fax Number	:

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

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	04/06/2022

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