MEDICARE: MRS. STEPHANIE COCA-PENNA 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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-23-65230	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790259265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE COCA-PENNA BCBA

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD STE 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	844-244-1818
Fax Number	:	888-512-0733

Provider Business Practice Location Address
First Line	:	1160 S SEMORAN BLVD STE AB
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1461
Country	:	US
Telephone Number	:	407-537-7522
Fax Number	:

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

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	06/03/2024

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