Provider Demographics
NPI:1801127451
Name:WHERRY, LAURA DENISE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DENISE
Last Name:WHERRY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 NEW BROAD ST APT 305
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6426
Mailing Address - Country:US
Mailing Address - Phone:407-280-0266
Mailing Address - Fax:407-852-3301
Practice Address - Street 1:4726 NEW BROAD ST APT 305
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6426
Practice Address - Country:US
Practice Address - Phone:407-280-0266
Practice Address - Fax:407-852-3301
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1020873103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst