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NPI Code Detail

MEDICARE: FLORIDA AUTISM CENTER

MEDICARE: FLORIDA AUTISM CENTER
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
1106E00000XAssistant Behavior Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1699294314
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORIDA AUTISM CENTER
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 470-816-6449
Fax Number :
Provider Business Practice Location Address
First Line : 4085 HANCOCK BRIDGE PKWY STE 101
Second Line :
City : NORTH FORT MYERS
State : FL
Zip : 33903-7220
Country : US
Telephone Number : 866-610-0580
Fax Number : 407-588-6294
Authorized Official
Title or Position : CEO
Name : JASON OWEN
Credential :
Telephone Number : 470-816-6449
Provider Enumeration Date : 09/13/2017
Last Update Date : 11/10/2022

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Directions to “FLORIDA AUTISM CENTER ” Practice Location

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