Provider Demographics
NPI:1134792963
Name:LAMSON, HEATHER CORINNE (BCBA)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:CORINNE
Last Name:LAMSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MOUNT HOPE AVE STE 680
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5672
Mailing Address - Country:US
Mailing Address - Phone:207-942-9305
Mailing Address - Fax:207-990-3954
Practice Address - Street 1:700 MOUNT HOPE AVE STE 680
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5672
Practice Address - Country:US
Practice Address - Phone:207-942-9305
Practice Address - Fax:207-990-3954
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
ME1-18-30361103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst