Provider Demographics
NPI:1558876227
Name:NEUBAUER, LAUREN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1501
Mailing Address - Country:US
Mailing Address - Phone:443-412-5488
Mailing Address - Fax:
Practice Address - Street 1:4513 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001
Practice Address - Country:US
Practice Address - Phone:443-412-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2018-12-19
Deactivation Date:2018-06-05
Deactivation Code:
Reactivation Date:2018-06-14
Provider Licenses
StateLicense IDTaxonomies
MDLBA443103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD103K00000XMedicaid