Healthcare Provider Details

I. General information

NPI: 1992159818
Provider Name (Legal Business Name): CRISTINA MARIA WHITEHOUSE PHD, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 04/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 NW 56TH TER
GAINESVILLE FL
32605-4481
US

IV. Provider business mailing address

1015 NW 56TH TER
GAINESVILLE FL
32605-4481
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-5520
  • Fax:
Mailing address:
  • Phone: 352-835-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-13738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: