Provider Demographics
NPI:1023553955
Name:LINAJA, LACEY (BCABA, BCBA)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:LINAJA
Suffix:
Gender:F
Credentials:BCABA, BCBA
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E LAKE MARY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-4116
Mailing Address - Country:US
Mailing Address - Phone:352-872-4098
Mailing Address - Fax:
Practice Address - Street 1:3357 W VINE ST STE 103
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4664
Practice Address - Country:US
Practice Address - Phone:352-872-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-19-10011106E00000X
106S00000X
FL1-23-68296103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician