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General NPI Number Information
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NPI Number | 1508589896
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Entity Type | Individual
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Provider Name | BRANDON ALEXANDER JOHNSON JR. AA
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Gender | Male
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 4964 N PALM AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-9111
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Country | US
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Telephone | 321-228-3765
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Fax |
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Provider Business Mailing Address
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Address Line | 181 E CEDARWOOD CIR
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City | KISSIMMEE
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State | FL
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Zip | 34743-9047
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Country | US
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Telephone | 407-870-3688
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-232179
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License Number State | FL
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