Healthcare Provider Details

I. General information

NPI: 1891280327
Provider Name (Legal Business Name): HEATHER BAZARNICKI FIORENTINO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 13TH ST # STREETD
COLUMBUS GA
31901-2204
US

IV. Provider business mailing address

1110 13TH ST
COLUMBUS GA
31901-2246
US

V. Phone/Fax

Practice location:
  • Phone: 706-223-0485
  • Fax:
Mailing address:
  • Phone: 706-223-0485
  • Fax: 732-761-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00234100
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA000338
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-29192
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: