Provider Demographics
NPI:1205422920
Name:ELDER, LAURYN NICOLE (BCBA)
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:NICOLE
Last Name:ELDER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:LAURYN
Other - Middle Name:NICOLE
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAURYN COOKE
Mailing Address - Street 1:4922 S TUPELO TURN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1026
Mailing Address - Country:US
Mailing Address - Phone:302-562-0735
Mailing Address - Fax:
Practice Address - Street 1:4922 S TUPELO TURN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1026
Practice Address - Country:US
Practice Address - Phone:302-562-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1-18-30734103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst