Provider Demographics
NPI:1326456823
Name:ANTHONY T. FISCHETTI, P.A.
Entity Type:Organization
Organization Name:ANTHONY T. FISCHETTI, P.A.
Other - Org Name:BASIX BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FISCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:855-747-6977
Mailing Address - Street 1:4185 US HIGHWAY 1
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5384
Mailing Address - Country:US
Mailing Address - Phone:855-747-6977
Mailing Address - Fax:888-272-2867
Practice Address - Street 1:4185 US HIGHWAY 1
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5384
Practice Address - Country:US
Practice Address - Phone:855-747-6977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-9208103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty