Healthcare Provider Details

I. General information

NPI: 1760966154
Provider Name (Legal Business Name): BREANNA E STREETER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREANNA E CRABTREE

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 BLUE STREAM WAY APT 5101
INLET BEACH FL
32461-8621
US

IV. Provider business mailing address

4620 N STATE ROAD 7 STE 300
LAUDERDALE LAKES FL
33319-5867
US

V. Phone/Fax

Practice location:
  • Phone: 850-896-3873
  • Fax: 855-508-6637
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65951
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: