Provider Demographics
NPI:1467605949
Name:SIMONDS, STACEY D (BCBA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:D
Last Name:SIMONDS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33509
Mailing Address - Street 2:1463 OAKFIELD DRIVE SUITE 102
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-438-8902
Mailing Address - Fax:813-438-8903
Practice Address - Street 1:1463 OAKFIELD DR STE 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3893
Practice Address - Country:US
Practice Address - Phone:813-438-8902
Practice Address - Fax:813-438-8903
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019458000Medicaid