Healthcare Provider Details

I. General information

NPI: 1467007328
Provider Name (Legal Business Name): DANIEL GREGORY BEBERNITZ BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 NW 2ND AVE STE 104
BOCA RATON FL
33431-6692
US

IV. Provider business mailing address

2840 NW 2ND AVE STE 104
BOCA RATON FL
33431-6692
US

V. Phone/Fax

Practice location:
  • Phone: 800-233-5976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36830
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: