Basic Information
| Provider Information | |||||||||
| NPI: | 1801127451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHERRY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4726 NEW BROAD ST APT 305 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328146426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072800266 | ||||||||
| FaxNumber: | 4078523301 | ||||||||
| Practice Location | |||||||||
| Address1: | 4726 NEW BROAD ST APT 305 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328146426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072800266 | ||||||||
| FaxNumber: | 4078523301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2010 | ||||||||
| LastUpdateDate: | 11/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1020873 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.