Individual
LAUREN RIDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
229 LAUREL RD, EAST NORTHPORT, NY 11731-1118
(631) 659-3337
(631) 659-3338
Mailing address
229 LAUREL RD, EAST NORTHPORT, NY 11731-1118
(631) 659-3337
(631) 659-3338
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-22105
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821451154
MAIDEN NAME
NY
Enumeration date
04/04/2016
Last updated
06/29/2021
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