Provider Demographics
NPI:1154600419
Name:BURDITT, CLIFFORD C JR (BCBA)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:C
Last Name:BURDITT
Suffix:JR
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7327
Mailing Address - Country:US
Mailing Address - Phone:904-503-0131
Mailing Address - Fax:904-636-2012
Practice Address - Street 1:4624 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-7327
Practice Address - Country:US
Practice Address - Phone:904-503-0131
Practice Address - Fax:636-600-2012
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-25857103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst