Provider Demographics
NPI:1316557820
Name:STADNICKI, BRANDON (RBT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:STADNICKI
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 SOUTHPOINT PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1702
Mailing Address - Country:US
Mailing Address - Phone:904-683-9515
Mailing Address - Fax:904-538-0714
Practice Address - Street 1:6816 SOUTHPOINT PKWY STE 500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1702
Practice Address - Country:US
Practice Address - Phone:904-683-9515
Practice Address - Fax:904-538-0714
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-131119103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst