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NPI Code Detail

MEDICARE: JUSTINE HENRY MS,BCBA

MEDICARE: JUSTINE HENRY MS,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 Analyst1-13-14889CA
2106S00000XBehavior Technician

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 : 1689004780
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTINE HENRY MS,BCBA
Provider Business Mailing Address
First Line : 150 W UNIVERSITY BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-6982
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1026 PATHFINDER WAY
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-3216
Country : US
Telephone Number : 321-655-5880
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2013
Last Update Date : 12/21/2023

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