Provider Demographics
NPI:1912133265
Name:LAPEN, LAURA T (MS BCBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:T
Last Name:LAPEN
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 TREYBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2745
Mailing Address - Country:US
Mailing Address - Phone:910-231-1909
Mailing Address - Fax:
Practice Address - Street 1:5204 TREYBROOKE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2745
Practice Address - Country:US
Practice Address - Phone:910-231-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-04-1513OtherBCBA
SCWP9917OtherMEDICAID WAIVER PROVIDER OF BEHAVIOR SUPPORT