Basic Information
| Provider Information | |||||||||
| NPI: | 1720416662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOUGH-YUDIN | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | M.S., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4575 SE DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349976826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Practice Location | |||||||||
| Address1: | 1475 SE 13TH ST | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349965813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725296749 | ||||||||
| FaxNumber: | 7722210899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2013 | ||||||||
| LastUpdateDate: | 10/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-01-0711 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.