Provider Demographics
NPI:1891211801
Name:CARSON, LAURA L (RBT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:CARSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 SE JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5843
Mailing Address - Country:US
Mailing Address - Phone:561-768-1190
Mailing Address - Fax:
Practice Address - Street 1:1365 SW VIZCAYA CIR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-1962
Practice Address - Country:US
Practice Address - Phone:772-349-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician