Provider Demographics
NPI:1205251519
Name:SHAY, LAURA (BCBA AND SLP/A)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SHAY
Suffix:
Gender:F
Credentials:BCBA AND SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 NEWBURY NECK RD
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:ME
Mailing Address - Zip Code:04684-3819
Mailing Address - Country:US
Mailing Address - Phone:207-356-8211
Mailing Address - Fax:
Practice Address - Street 1:1372 NEWBURY NECK RD
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:ME
Practice Address - Zip Code:04684-3819
Practice Address - Country:US
Practice Address - Phone:207-356-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-23
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESAS22902355S0801X
1-18-32169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESAS2290OtherMAINE PROFESSIONAL LICENSING
1-18-32169OtherBACB