MEDICARE: PRESNELIE PRESENDIEU RBT

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-21-150758	OTHER	GA	BACB

General Provider Information

NPI Number	:	1750970851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRESNELIE PRESENDIEU RBT

Provider Business Mailing Address
First Line	:	486 S MALTON CT
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-4346
Country	:	US
Telephone Number	:	561-294-8637
Fax Number	:

Provider Business Practice Location Address
First Line	:	486 S MALTON CT
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-4346
Country	:	US
Telephone Number	:	561-294-8637
Fax Number	:

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

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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Directions to “ PRESNELIE PRESENDIEU RBT” Practice Location

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