1134679889 NPI number — LAUREN JANE CORCORAN BCBA, LABA

Table of content: LAUREN JANE CORCORAN BCBA, LABA (NPI 1134679889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134679889 NPI number — LAUREN JANE CORCORAN BCBA, LABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORCORAN
Provider First Name:
LAUREN
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA, LABA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CONLEY
Provider Other First Name:
LAUREN
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA, LABA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134679889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 LINCOLN ST STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02043-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-749-3606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)