Individual
CHRISTINE TRACY FISHERO-FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1321 MCCLELLAND AVE, PORT ST JOE, FL 32456-2041
(850) 227-4392
(850) 229-6166
Mailing address
3076 ANDERSON RD, GREEN COVE SPRINGS, FL 32043-9301
(850) 227-4392
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
10-06-3112
FL
Other
Enumeration date
02/22/2009
Last updated
04/18/2016
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