Basic Information
| Provider Information | |||||||||
| NPI: | 1558672857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMARCA | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7901 E 88TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462561235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178495437 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7901 E 88TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462561235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178495437 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-05-2495 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.