1720398894 NPI number — MRS. ALLISON MARIE BERARD M.S., BCBA

Table of content: MRS. ALLISON MARIE BERARD M.S., BCBA (NPI 1720398894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720398894 NPI number — MRS. ALLISON MARIE BERARD M.S., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERARD
Provider First Name:
ALLISON
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMILTON
Provider Other First Name:
ALLISON
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720398894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
824 BANBURY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORANGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32129-3753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-221-3076
Provider Business Mailing Address Fax Number:
866-610-0580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1128 BEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32114-5747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-267-3161
Provider Business Practice Location Address Fax Number:
866-610-0580
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019902300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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