Provider Demographics
NPI:1285163782
Name:RICHARDS, VICTORIA (BCABA)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:125 E NASA BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1900
Mailing Address - Country:US
Mailing Address - Phone:321-372-6813
Mailing Address - Fax:
Practice Address - Street 1:125 E NASA BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-372-6813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-35115106S00000X
FL0-19-10613106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021220300Medicaid