Provider Demographics
NPI:1265773444
Name:WASANO, LAUREN C (MA, BCBA)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:C
Last Name:WASANO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 9TH ST STE 219
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2557
Mailing Address - Country:US
Mailing Address - Phone:510-665-9700
Mailing Address - Fax:510-665-9400
Practice Address - Street 1:2560 9TH ST STE 219
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2557
Practice Address - Country:US
Practice Address - Phone:510-665-9700
Practice Address - Fax:510-665-9400
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-07-3310OtherBCBA