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NPI Code Detail

MEDICARE: MARILYN PRCIC BCBA

MEDICARE: MARILYN PRCIC BCBA
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
1103K00000XBehavior Analyst
2103K00000XBehavior Analyst1-11-8563

General Provider Information

NPI Number : 1508153701
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN PRCIC BCBA
Provider Business Mailing Address
First Line : 175 MIDDLE STREET
Second Line : SUITE 1201
City : LAKE MARY
State : FL
Zip : 32746
Country : US
Telephone Number : 866-610-0580
Fax Number :
Provider Business Practice Location Address
First Line : 17815 HUNTING BOW CIR
Second Line :
City : LUTZ
State : FL
Zip : 33558-5401
Country : US
Telephone Number : 866-610-0580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2011
Last Update Date : 06/07/2017

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