Provider Demographics
NPI:1558955526
Name:DEMAN, LAUREN (RBT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DEMAN
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 1:165 W NURSERY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-3833
Mailing Address - Country:US
Mailing Address - Phone:609-839-9816
Mailing Address - Fax:
Practice Address - Street 1:305 MACK BAYOU RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7199
Practice Address - Country:US
Practice Address - Phone:850-213-4595
Practice Address - Fax:850-213-4596
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB599046106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician