Provider Demographics
NPI:1972905339
Name:MCGOVERN, CHRISTY ROSE (BCBA)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ROSE
Last Name:MCGOVERN
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 KNOLLVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4655
Mailing Address - Country:US
Mailing Address - Phone:386-237-7144
Mailing Address - Fax:
Practice Address - Street 1:778 KNOLLVIEW BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4655
Practice Address - Country:US
Practice Address - Phone:386-237-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL0-17-28572103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst