Provider Demographics
NPI:1780169565
Name:LANZON, LAUREN A (BCBA, LISW-CP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:LANZON
Suffix:
Gender:F
Credentials:BCBA, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MICHELL DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5339
Mailing Address - Country:US
Mailing Address - Phone:540-892-6981
Mailing Address - Fax:
Practice Address - Street 1:224 THORNCREST DR
Practice Address - Street 2:
Practice Address - City:PAULINE
Practice Address - State:SC
Practice Address - Zip Code:29374-1626
Practice Address - Country:US
Practice Address - Phone:864-590-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC134431041C0700X
SC1-18-32781103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical