Provider Demographics
NPI:1043689102
Name:WOMACK-GAYTAN, DEBRA (BCBA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WOMACK-GAYTAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 ORGANZA PL
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766-6028
Mailing Address - Country:US
Mailing Address - Phone:321-689-2499
Mailing Address - Fax:
Practice Address - Street 1:293 ORGANZA PL
Practice Address - Street 2:
Practice Address - City:CHULUOTA
Practice Address - State:FL
Practice Address - Zip Code:32766-6028
Practice Address - Country:US
Practice Address - Phone:321-689-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0471103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst