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General NPI Number Information
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NPI Number | 1568857225
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Entity Type | Individual
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Provider Name | BARBARA ELLIS-WOROCH PHD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 415 N RICHARD JACKSON BLVD STE 209
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-3694
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Country | US
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Telephone | 850-866-0441
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Fax | 850-254-0827
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Provider Business Mailing Address
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Address Line | 415 N RICHARD JACKSON BLVD STE 209
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-3694
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Country | US
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Telephone | 850-866-0441
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Fax | 850-254-0827
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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 | 17-254-61
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License Number State | FL
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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 | 1-17-25461
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License Number State | FL
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