Provider Demographics
NPI:1164973624
Name:ODONNELL, LAUREN (MS BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ODONNELL
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 1:14141 RIVERSIDE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2344
Mailing Address - Country:US
Mailing Address - Phone:413-301-2019
Mailing Address - Fax:
Practice Address - Street 1:13400 RIVERSIDE DR STE 209
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2545
Practice Address - Country:US
Practice Address - Phone:818-308-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-14-15526103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst