Provider Demographics
NPI:1316077399
Name:PULCINI, JANICE GABOURY (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:GABOURY
Last Name:PULCINI
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4020
Mailing Address - Country:US
Mailing Address - Phone:352-373-4411
Mailing Address - Fax:352-373-4455
Practice Address - Street 1:1408 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4020
Practice Address - Country:US
Practice Address - Phone:352-373-4411
Practice Address - Fax:352-373-4455
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FL1-04-1675103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85824OtherEARLY STEPS
FL687672296Medicaid
FL017661600Medicaid
FL811848500Medicaid