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Organization
BEHAVIOR SERVICES OF BREVARD COUNTY
Active
Organization
BEHAVIOR SERVICES OF BREVARD COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAREN WAGNER BCBA-D (CEO/PRESIDENT)
(321) 639-9800
Entity
Organization
Contact information
Practice address
550 SOLUTIONS WAY, ROCKLEDGE, FL 32955-3620
(321) 739-9800
Mailing address
36227 E ELDORADO LAKE DR, EUSTIS, FL 32736-9474
(941) 357-6840
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1041993
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041993
BCBA-D CERTIFICATION NUMBER
FL
01
—
S60061568500
DRIVER'S LICENSE NUMBER
FL
Enumeration date
01/20/2017
Last updated
01/20/2017
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