1457514085 NPI number — JASON WILLIAM LANTIER MA, BCBA

Table of content: JASON WILLIAM LANTIER MA, BCBA (NPI 1457514085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457514085 NPI number — JASON WILLIAM LANTIER MA, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANTIER
Provider First Name:
JASON
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, BCBA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457514085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19019 VENTURA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91356-3253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-345-2345
Provider Business Mailing Address Fax Number:
818-758-8015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 PALMER AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LARCHMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10538-3059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-833-1303
Provider Business Practice Location Address Fax Number:
914-833-1305
Provider Enumeration Date:
07/03/2008

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 , with the licence number:  1-09-5131 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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