MEDICARE: MR. MICHAEL ERLE HANCOCK RBT, MA

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	106S00000X	Behavior Technician	RBT-18-50382
2	101YM0800X	Mental Health Counselor	IMH13863	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-18-50382	OTHER		BACB

General Provider Information

NPI Number	:	1467861419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ERLE HANCOCK RBT, MA

Provider Business Mailing Address
First Line	:	13121 ATLANTIC BLVD STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-0102
Country	:	US
Telephone Number	:	904-491-2111
Fax Number	:	904-512-0613

Provider Business Practice Location Address
First Line	:	13121 ATLANTIC BLVD STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-0102
Country	:	US
Telephone Number	:	904-491-2111
Fax Number	:	904-512-0613

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

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	06/12/2020

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