Provider Demographics
NPI:1588062483
Name:SACCHETTI, BROOKE CHARLAND (MA, BCBA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:CHARLAND
Last Name:SACCHETTI
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:ECKHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9994 SOWDER VILLAGE SQ # 102
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5464
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-16149103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-14-16149OtherBCBA