Provider Demographics
NPI:1700266871
Name:ANDERSON, LAUREN ALTMAN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALTMAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:DANIELLE
Other - Last Name:ALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1319 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-2307
Mailing Address - Country:US
Mailing Address - Phone:727-320-6479
Mailing Address - Fax:
Practice Address - Street 1:4018 W LAWN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1334
Practice Address - Country:US
Practice Address - Phone:813-461-5380
Practice Address - Fax:813-642-4502
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0156439103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst