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General NPI Number Information
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NPI Number | 1144627357
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Entity Type | Individual
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Provider Name | CASSIE MARTINE ZIESK BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 1912 DAIRY RD
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-4046
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Country | US
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Telephone | 321-537-8467
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Fax |
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Provider Business Mailing Address
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Address Line | 2502 SAINT JOHNS LN
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City | MELBOURNE
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State | FL
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Zip | 32935-3636
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Country | US
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Telephone | 321-537-8467
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Fax | 321-306-2880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-15-04647
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-37878
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License Number State | FL
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