Provider Demographics
NPI:1164811584
Name:HENDERSON, LAURA (BCBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HADDONFIELD BERLIN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1228
Mailing Address - Country:US
Mailing Address - Phone:856-346-0005
Mailing Address - Fax:
Practice Address - Street 1:250 HADDONFIELD BERLIN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1228
Practice Address - Country:US
Practice Address - Phone:856-346-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1096358103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst