Provider Demographics
NPI:1467236786
Name:BOOTH, LAUREN (RBT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S PARLIAMENT DR STE 205
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6311
Mailing Address - Country:US
Mailing Address - Phone:757-450-8507
Mailing Address - Fax:757-585-3544
Practice Address - Street 1:6328 BUCKNELL CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4420
Practice Address - Country:US
Practice Address - Phone:757-450-8507
Practice Address - Fax:757-585-3544
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-291680106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician