Provider Demographics
NPI:1104445592
Name:DARDENNE, ABBY ALYSE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:ALYSE
Last Name:DARDENNE
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17040 THOMAS LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE TETE
Mailing Address - State:LA
Mailing Address - Zip Code:70740-3026
Mailing Address - Country:US
Mailing Address - Phone:225-776-4473
Mailing Address - Fax:
Practice Address - Street 1:7932 SUMMA AVE STE B2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3736
Practice Address - Country:US
Practice Address - Phone:225-349-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-452103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-41289OtherBACB CERTIFICATION
LAL-452OtherLOUISIANA BEHAVIOR ANALYST BOARD