MEDICARE: CIERRA L WOODS RBT

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

Other Identifiers

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

General Provider Information

NPI Number	:	1932761913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERRA L WOODS RBT

Provider Business Mailing Address
First Line	:	3903 SUTTON PLACE BLVD APT 503
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-8459
Country	:	US
Telephone Number	:	904-309-3189
Fax Number	:

Provider Business Practice Location Address
First Line	:	3903 SUTTON PLACE BLVD APT 503
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-8459
Country	:	US
Telephone Number	:	904-309-3189
Fax Number	:

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

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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