MEDICARE: CLEARBRIDGE COLLECTIVE LLC

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

General Provider Information

NPI Number	:	1295682433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARBRIDGE COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	111 E LAKE MARY DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-4116
Country	:	US
Telephone Number	:
Fax Number	:	407-989-4040

Provider Business Practice Location Address
First Line	:	111 E LAKE MARY DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-4116
Country	:	US
Telephone Number	:	352-872-4098
Fax Number	:	407-989-4040

Authorized Official
Title or Position	:	OWNER
Name	:	LACEY LINAJA
Credential	:	BCBA
Telephone Number	:	352-872-4098

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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