Provider Demographics
NPI:1821451154
Name:RIDALL, LAUREN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RIDALL
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:229 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1118
Mailing Address - Country:US
Mailing Address - Phone:631-659-3337
Mailing Address - Fax:631-659-3338
Practice Address - Street 1:229 LAUREL RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1118
Practice Address - Country:US
Practice Address - Phone:631-659-3337
Practice Address - Fax:631-659-3338
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-16-22105103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1821451154OtherMAIDEN NAME