Provider Demographics
NPI:1508100751
Name:LACAMPAGNE, JOHN (BCBA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LACAMPAGNE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HANGAR WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2456
Mailing Address - Country:US
Mailing Address - Phone:831-786-0600
Mailing Address - Fax:831-786-0644
Practice Address - Street 1:6 HANGAR WAY
Practice Address - Street 2:SUITE A
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2456
Practice Address - Country:US
Practice Address - Phone:831-786-0600
Practice Address - Fax:831-786-0644
Is Sole Proprietor?:No
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8996103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst