Provider Demographics
NPI:1548428451
Name:LAMM, NYLA CLAIRE (LCSWEDD BCBA-D LBA)
Entity Type:Individual
Prefix:DR
First Name:NYLA
Middle Name:CLAIRE
Last Name:LAMM
Suffix:
Gender:F
Credentials:LCSWEDD BCBA-D LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 ALDRICH LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NY
Mailing Address - Zip Code:11948-1017
Mailing Address - Country:US
Mailing Address - Phone:631-298-7195
Mailing Address - Fax:631-298-7195
Practice Address - Street 1:4150 ALDRICH LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NY
Practice Address - Zip Code:11948-1017
Practice Address - Country:US
Practice Address - Phone:631-298-7195
Practice Address - Fax:631-298-7195
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034492-11041C0700X
NY000849103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1-09-6594OtherBEHAVIOR ANALYST CERTIFICATION BOARD