Provider Demographics
NPI:1467073700
Name:MARSH, WILLIAM T (BCBA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:MARSH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6182 BALSAM ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8890
Mailing Address - Country:US
Mailing Address - Phone:321-806-0851
Mailing Address - Fax:
Practice Address - Street 1:65 E NASA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1961
Practice Address - Country:US
Practice Address - Phone:321-541-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-00-0366103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst