Provider Demographics
NPI:1841855392
Name:HARTLINE, LYNDSEY JANE (RBT)
Entity type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:JANE
Last Name:HARTLINE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 S JOG RD STE A-3
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1247
Mailing Address - Country:US
Mailing Address - Phone:561-336-0358
Mailing Address - Fax:
Practice Address - Street 1:15200 S JOG RD STE A-3
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1247
Practice Address - Country:US
Practice Address - Phone:561-336-0358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194996280Medicaid