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General NPI Number Information
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NPI Number | 1427694207
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Entity Type | Individual
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Provider Name | ASHLEY KRISTEN FONSECA
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Gender | Female
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 701 BELVEDERE RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33405-1107
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Country | US
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Telephone | 561-699-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 4620 N STATE ROAD 7 STE 300
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5867
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Country | US
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Telephone | 561-699-3524
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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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 |
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License Number State |
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