Provider Demographics
NPI:1154707412
Name:WEEDEN, MARC (BCBA-D)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:WEEDEN
Suffix:
Gender:M
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N BELCHER RD STE 249
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1300
Mailing Address - Country:US
Mailing Address - Phone:727-799-3330
Mailing Address - Fax:
Practice Address - Street 1:1501 N BELCHER RD STE 249
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1300
Practice Address - Country:US
Practice Address - Phone:727-799-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-08-4597103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst