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Individual

WIDLEY HERARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2484 SAND LAKE RD, ORLANDO, FL 32809-7672
(407) 342-7939
(888) 808-5278
Mailing address
151 W CHURCH AVE, LONGWOOD, FL 32750-4105

Taxonomy

Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
106S00000X
Behavior Technician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
112950000
FL
Enumeration date
02/25/2022
Last updated
12/10/2024
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