Provider Demographics
NPI:1063768414
Name:PETERS, KERRI PATRICIA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:PATRICIA
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:PATRICIA
Other - Last Name:BERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:749 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-2250
Mailing Address - Country:US
Mailing Address - Phone:940-391-9411
Mailing Address - Fax:
Practice Address - Street 1:749 CENTER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-2250
Practice Address - Country:US
Practice Address - Phone:940-391-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-10-7682103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst