Individual
CAITLIN LARA MADELYN POWDERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3665 ELOISE ST, JACKSONVILLE, FL 32205-9006
(978) 408-9462
Mailing address
3665 ELOISE ST, JACKSONVILLE, FL 32205-9006
(978) 408-9462
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-46989
FL
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
19-84604
—
Other
Enumeration date
05/07/2019
Last updated
01/22/2021
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