Healthcare Provider Details

I. General information

NPI: 1093060394
Provider Name (Legal Business Name): ELAINA LEGROS ED.S, NCSP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 SE DIXIE HWY
STUART FL
34997-6826
US

IV. Provider business mailing address

806 SPRINGVIEW DR
ORLANDO FL
32803-6936
US

V. Phone/Fax

Practice location:
  • Phone: 239-839-1301
  • Fax:
Mailing address:
  • Phone: 239-839-1301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8409
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1149192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: