MEDICARE: KELLY LYNN BERNARD M.ED, BCBA, LABA

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	2032-MH-B1	MA

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	:	1346762523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNN BERNARD M.ED, BCBA, LABA

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	407-915-7729
Fax Number	:

Provider Business Practice Location Address
First Line	:	7326 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5518
Country	:	US
Telephone Number	:	727-364-2212
Fax Number	:

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

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	08/13/2019

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