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General NPI Number Information
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NPI Number | 1457816530
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Entity Type | Individual
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Provider Name | HALLIE MARIE ERTEL BCBA-D
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Gender | Female
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 1717 S ORANGE AVE STE 100
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City | ORLANDO
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State | FL
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Zip | 32806-2946
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Country | US
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Telephone | 407-650-7000
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Fax | 407-567-5924
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Provider Business Mailing Address
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Address Line | 431 LUNA BELLA LN APT 322
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-5364
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Country | US
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Telephone | 757-375-3461
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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 |
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License Number State |
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