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NPI Code Detail

MEDICARE: SAMANTHA ACKERMAN MS, BCBA

MEDICARE: SAMANTHA ACKERMAN 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 Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst1-23-64713GA

General Provider Information

NPI Number : 1831663947
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ACKERMAN MS, BCBA
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PARKWAY SUITE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 866-610-0580
Fax Number :
Provider Business Practice Location Address
First Line : 535 RIVERSTONE PARKWAY SUITE 101
Second Line :
City : CANTON
State : GA
Zip : 30114-2566
Country : US
Telephone Number : 855-942-0995
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2019
Last Update Date : 03/16/2023

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