Provider Demographics
NPI:1992182760
Name:DEMELLO, LORIANN SAMANTHA (BCABA)
Entity Type:Individual
Prefix:
First Name:LORIANN
Middle Name:SAMANTHA
Last Name:DEMELLO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CLARKE SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6021
Mailing Address - Country:US
Mailing Address - Phone:561-360-3169
Mailing Address - Fax:
Practice Address - Street 1:1815 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-360-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0145945103K00000X
FL0-14-5945106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst