Provider Demographics
NPI:1720416662
Name:LOUGH-YUDIN, PATRICIA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LOUGH-YUDIN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 SE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6826
Mailing Address - Country:US
Mailing Address - Phone:866-832-6727
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:1475 SE 13TH ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-5813
Practice Address - Country:US
Practice Address - Phone:772-529-6749
Practice Address - Fax:772-221-0899
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0711103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst