Provider Demographics
NPI:1104398544
Name:MERRIMAN, KORI NICOLE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:NICOLE
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:NICOLE
Other - Last Name:DISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5216 4TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5621
Mailing Address - Country:US
Mailing Address - Phone:941-744-1211
Mailing Address - Fax:961-666-7419
Practice Address - Street 1:4442 5TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1531
Practice Address - Country:US
Practice Address - Phone:941-744-1211
Practice Address - Fax:941-666-7419
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst