Provider Demographics
NPI:1568000701
Name:LAURENT, VANESSA (BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:LAURENT
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 SECANE RD
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2810
Mailing Address - Country:US
Mailing Address - Phone:610-864-7870
Mailing Address - Fax:
Practice Address - Street 1:2312 SECANE RD
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-2810
Practice Address - Country:US
Practice Address - Phone:610-864-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-18-29496103K00000X
NVLBA0277103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst