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General NPI Number Information
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NPI Number | 1245570647
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Entity Type | Individual
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Provider Name | DEBBI WAGNER SANTOS M.S. BCABA
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Gender | Female
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 4890 WAGON MASTER TRL
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City | MICCO
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State | FL
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Zip | 32976-2736
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Country | US
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Telephone | 772-664-1620
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Fax |
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Provider Business Mailing Address
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Address Line | 550 SAINT JOHNS ST
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City | COCOA
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State | FL
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Zip | 32922-7241
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Country | US
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Telephone | 772-713-6978
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0-02-0614
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 103K00000X
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License Number State | FL
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