Healthcare Provider Details

I. General information

NPI: 1285570465
Provider Name (Legal Business Name): MAIGEN PEARLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 KINGSLEY AVE STE 6
ORANGE PARK FL
32073-4583
US

IV. Provider business mailing address

1543 KINGSLEY AVE STE 6
ORANGE PARK FL
32073-4583
US

V. Phone/Fax

Practice location:
  • Phone: 904-305-2069
  • Fax:
Mailing address:
  • Phone: 904-305-2069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-519359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: