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General NPI Number Information
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NPI Number | 1548747009
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Entity Type | Individual
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Provider Name | JEFFREY PISACRETA MS.ED., BCBA
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Gender | Male
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 2574 COMMERCE PKWY
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City | NORTH PORT
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State | FL
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Zip | 34289-9334
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Country | US
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Telephone | 856-304-0547
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Fax |
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Provider Business Mailing Address
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Address Line | 300 INTERNATIONAL PKWY STE 200
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City | LAKE MARY
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State | FL
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Zip | 32746-5028
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Country | US
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Telephone | 407-915-7729
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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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