Provider Demographics
NPI:1578183877
Name:PAGE, LAUREN R (RBT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:PAGE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15210 AMBERLY DR APT 515
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2187
Mailing Address - Country:US
Mailing Address - Phone:863-781-5553
Mailing Address - Fax:
Practice Address - Street 1:27604 CASHFORD CIR STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6952
Practice Address - Country:US
Practice Address - Phone:813-345-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-114026106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician