Provider Demographics
NPI:1215423751
Name:GIBEAULT, LAUREN AMBER (MS, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:AMBER
Last Name:GIBEAULT
Suffix:
Gender:F
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2161
Mailing Address - Country:US
Mailing Address - Phone:774-402-0257
Mailing Address - Fax:
Practice Address - Street 1:59 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2161
Practice Address - Country:US
Practice Address - Phone:774-402-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3930103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst