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General NPI Number Information
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NPI Number | 1285910612
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Entity Type | Organization
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Legal Business Name | FLORIDA CENTER FOR BEHAVIOR ANALYSIS INC.
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 405 S SUMMIT ST STE F
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City | CRESCENT CITY
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State | FL
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Zip | 32112-3048
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Country | US
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Telephone | 800-613-1497
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Fax | 386-698-0979
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Provider Business Mailing Address
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Address Line | 405 S SUMMIT ST STE F
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City | CRESCENT CITY
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State | FL
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Zip | 32112-3048
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Country | US
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Telephone | 800-613-1497
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Fax | 386-698-0979
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Authorized Official
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Title or Position | SECRETARY/BOD MEMBER
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Name | MR. ROBERT L DEFRANCO
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Credential | BCBA
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Telephone | 386-214-8199
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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 | 1-10-6870
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License Number State | FL
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