Provider Demographics
NPI:1972992782
Name:BROCKE, LAUREN (BCBA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BROCKE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 CRONRIDGE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2261
Mailing Address - Country:US
Mailing Address - Phone:410-517-1113
Mailing Address - Fax:410-517-2113
Practice Address - Street 1:11500 CRONRIDGE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2261
Practice Address - Country:US
Practice Address - Phone:410-517-1113
Practice Address - Fax:410-517-2113
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst