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NPI Code Detail

MEDICARE: MRS. TAYLOR DIANE MATERIA BCBA

MEDICARE: MRS. TAYLOR DIANE MATERIA BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-24-78476FL
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1154934545
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAYLOR DIANE MATERIA BCBA
Provider Business Mailing Address
First Line : 6416 NW 5TH WAY
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-6112
Country : US
Telephone Number : 888-754-0398
Fax Number : 954-982-6491
Provider Business Practice Location Address
First Line : 12735 GRAN BAY PKWY W STE 204
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32258-4499
Country : US
Telephone Number : 888-754-0398
Fax Number : 954-982-6491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 12/29/2025

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