MEDICARE: JUDITH G COPES BCBA, LBA

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	103K00000X	Behavior Analyst	2020-016	AL
3	103K00000X	Behavior Analyst	1-18-29344	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174078406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH G COPES BCBA, LBA

Provider Business Mailing Address
First Line	:	1808 SENTRY OAK CT
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-3762
Country	:	US
Telephone Number	:	904-923-9179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 US HIGHWAY 17
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-7122
Country	:	US
Telephone Number	:	904-297-0054
Fax Number	:

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

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	12/04/2023

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