Provider Demographics
NPI:1104361237
Name:FISH, LAUREN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 VERONICA AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4611
Mailing Address - Country:US
Mailing Address - Phone:925-487-6124
Mailing Address - Fax:
Practice Address - Street 1:2560 9TH STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2516
Practice Address - Country:US
Practice Address - Phone:508-813-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst