Provider Demographics
NPI:1912407958
Name:LARA, VERONICA JEANETTE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:JEANETTE
Last Name:LARA
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 S CONGRESS AVE STE E500-109
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7379
Mailing Address - Country:US
Mailing Address - Phone:512-503-4801
Mailing Address - Fax:
Practice Address - Street 1:8708 S CONGRESS AVE STE E500-109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7379
Practice Address - Country:US
Practice Address - Phone:512-503-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-35951103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst