Provider Demographics
NPI:1396524484
Name:SPIDELL, LAUREN S
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:S
Last Name:SPIDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 E CRYSTAL LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3204
Mailing Address - Country:US
Mailing Address - Phone:407-701-1155
Mailing Address - Fax:
Practice Address - Street 1:7594 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5188
Practice Address - Country:US
Practice Address - Phone:407-473-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-297998106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician