Provider Demographics
NPI:1629306972
Name:DEHAINAUT, ROBIN LANE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LANE
Last Name:DEHAINAUT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:ELIZABETH
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:1353 LOTUS PATH
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-241-0246
Mailing Address - Fax:727-240-4720
Practice Address - Street 1:18946 NORTH DALE MABRY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548
Practice Address - Country:US
Practice Address - Phone:727-241-0246
Practice Address - Fax:727-240-4720
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-09-5814103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017480200Medicaid
1-09-5814OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD