MEDICARE: ROBERT PULVER III 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
1	103K00000X	Behavior Analyst	02516189	FL

General Provider Information

NPI Number	:	1710869102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PULVER III BCABA

Provider Business Mailing Address
First Line	:	149 RIVER PARK BLVD
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-8129
Country	:	US
Telephone Number	:	772-646-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 RIVER PARK BLVD
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-8129
Country	:	US
Telephone Number	:	772-646-2414
Fax Number	:

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

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	07/24/2025

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