Provider Demographics
NPI:1114657590
Name:BLAHER, NEAL
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:BLAHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180008
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32718-0008
Mailing Address - Country:US
Mailing Address - Phone:407-620-5036
Mailing Address - Fax:
Practice Address - Street 1:706 TURNBULL AVE STE 204
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6476
Practice Address - Country:US
Practice Address - Phone:407-620-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT19-790001106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician