MEDICARE: CHRISTY ROSE MCGOVERN 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
1	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst	0-17-28572	FL

General Provider Information

NPI Number	:	1972905339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY ROSE MCGOVERN BCBA

Provider Business Mailing Address
First Line	:	778 KNOLLVIEW BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4655
Country	:	US
Telephone Number	:	386-237-7144
Fax Number	:

Provider Business Practice Location Address
First Line	:	778 KNOLLVIEW BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4655
Country	:	US
Telephone Number	:	386-237-7144
Fax Number	:

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

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	03/10/2025

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