Provider Demographics
NPI:1568934552
Name:BURWELL WOODRUFF, LORRAINE THERESE (MS, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:THERESE
Last Name:BURWELL WOODRUFF
Suffix:
Gender:F
Credentials:MS, BCBA, COBA
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:THERESE
Other - Last Name:BURWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCABA
Mailing Address - Street 1:970 PLEASANT PLAIN RD E
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-9261
Mailing Address - Country:US
Mailing Address - Phone:765-914-6489
Mailing Address - Fax:
Practice Address - Street 1:970 PLEASANT PLAIN RD E
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-9261
Practice Address - Country:US
Practice Address - Phone:765-914-6489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00501103K00000X, 103K00000X
IN1-18-32881103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300021667Medicaid
1-18-32881OtherBCBA CERTIFICATE