Healthcare Provider Details

I. General information

NPI: 1184221251
Provider Name (Legal Business Name): MADISON ELIZABETH GUINN MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

514 WALDEN LN
SAVANNAH GA
31405-8410
US

V. Phone/Fax

Practice location:
  • Phone: 772-329-6317
  • Fax:
Mailing address:
  • Phone: 812-929-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-98201
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB524925
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: