MEDICARE: BRIDGET ROSE COURTNEY MUNCY RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1043912033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET ROSE COURTNEY MUNCY RBT

Provider Business Mailing Address
First Line	:	2223 ASTOR ST APT LIDO11
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5668
Country	:	US
Telephone Number	:	276-694-9645
Fax Number	:

Provider Business Practice Location Address
First Line	:	13241 BARTRAM PARK BLVD UNIT 801
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5216
Country	:	US
Telephone Number	:	904-449-5186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/09/2026

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