Provider Demographics
NPI:1043912033
Name:MUNCY, BRIDGET ROSE COURTNEY (RBT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ROSE COURTNEY
Last Name:MUNCY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4326
Mailing Address - Country:US
Mailing Address - Phone:904-579-4779
Mailing Address - Fax:
Practice Address - Street 1:2377 MARKET DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4326
Practice Address - Country:US
Practice Address - Phone:904-579-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician