Provider Demographics
NPI:1740542604
Name:BRIGGIN, LAURA (BEHAVIOR ANALYST)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:BRIGGIN
Suffix:
Gender:F
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 CYPRESS DRIVE, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:415-720-9328
Mailing Address - Fax:707-559-2466
Practice Address - Street 1:3835 CYPRESS DR STE 103
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6966
Practice Address - Country:US
Practice Address - Phone:415-720-9328
Practice Address - Fax:707-559-2466
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1641103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst