Provider Demographics
NPI:1285910612
Name:FLORIDA CENTER FOR BEHAVIOR ANALYSIS INC.
Entity type:Organization
Organization Name:FLORIDA CENTER FOR BEHAVIOR ANALYSIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/BOD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:386-214-8199
Mailing Address - Street 1:405 S SUMMIT ST
Mailing Address - Street 2:STE F
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-3048
Mailing Address - Country:US
Mailing Address - Phone:800-613-1497
Mailing Address - Fax:386-698-0979
Practice Address - Street 1:405 S SUMMIT ST
Practice Address - Street 2:STE F
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-3048
Practice Address - Country:US
Practice Address - Phone:800-613-1497
Practice Address - Fax:386-698-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-10-6870103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty