MEDICARE: APRIL GROENEWEG M.S. 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1386060390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL GROENEWEG M.S. BCBA

Provider Business Mailing Address
First Line	:	3048 GRAND PALM WAY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-5662
Country	:	US
Telephone Number	:	843-901-3258
Fax Number	:	850-739-7890

Provider Business Practice Location Address
First Line	:	3048 GRAND PALM WAY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-5662
Country	:	US
Telephone Number	:	843-901-3258
Fax Number	:	850-739-7890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2014
Last Update Date	:	03/02/2020

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