Provider Demographics
NPI:1093373664
Name:WHITTAKER, CORINNA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:CORINNA
Other - Middle Name:
Other - Last Name:KUCHENBECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 NW 1ST AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3382
Mailing Address - Country:US
Mailing Address - Phone:754-703-8199
Mailing Address - Fax:
Practice Address - Street 1:1776 N PINE ISLAND RD STE 108
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5200
Practice Address - Country:US
Practice Address - Phone:754-703-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst