Provider Demographics
NPI:1164089587
Name:DRAKE, CHRISTINE MARY (MA, BCABA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARY
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 SW 173RD WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2604
Mailing Address - Country:US
Mailing Address - Phone:718-908-9534
Mailing Address - Fax:
Practice Address - Street 1:3346 SW 173RD WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2604
Practice Address - Country:US
Practice Address - Phone:718-908-9534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-08-2438103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst