Provider Demographics
NPI:1154934545
Name:MATERIA, TAYLOR DIANE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:DIANE
Last Name:MATERIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:DIANE
Other - Last Name:RENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3415 N WESTMORELAND DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-3639
Mailing Address - Country:US
Mailing Address - Phone:407-256-9653
Mailing Address - Fax:
Practice Address - Street 1:3503 KERNAN BLVD S STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-3605
Practice Address - Country:US
Practice Address - Phone:407-256-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-78476103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician