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NPI Code Detail

MEDICARE: BETHANY ANAN BCABA

MEDICARE: BETHANY ANAN BCABA
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
1247200000XOther Technician
2103K00000XBehavior Analyst0-16-7460FL

Other Identifiers

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

General Provider Information

NPI Number : 1588019814
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY ANAN BCABA
Provider Business Mailing Address
First Line : 519 LAKEVIEW ST
Second Line :
City : ORLANDO
State : FL
Zip : 32804-6822
Country : US
Telephone Number : 407-342-6650
Fax Number :
Provider Business Practice Location Address
First Line : 3730 GATLIN WOODS DR
Second Line :
City : ORLANDO
State : FL
Zip : 32812-7610
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2016
Last Update Date : 01/12/2017

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Directions to “ BETHANY ANAN BCABA” Practice Location

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