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Organization
MBKNOWLES
Active
Organization
MBKNOWLES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADISON BRITTANY KNOWLES (BEHAVIOR TECHNICIAN)
(772) 284-1873
Entity
Organization
Contact information
Practice address
2065 SE LENNARD RD APT 307, PORT ST LUCIE, FL 34952-4753
(772) 284-1873
(772) 207-5808
Mailing address
2065 SE LENNARD RD APT 307, PORT ST LUCIE, FL 34952
(772) 284-1873
(772) 207-5808
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017716200
—
FL
Enumeration date
03/31/2017
Last updated
03/31/2017
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