Provider Demographics
NPI:1467861419
Name:HANCOCK, MICHAEL ERLE (RBT, MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ERLE
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:RBT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 ATLANTIC BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-0102
Mailing Address - Country:US
Mailing Address - Phone:904-491-2111
Mailing Address - Fax:904-512-0613
Practice Address - Street 1:13121 ATLANTIC BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-0102
Practice Address - Country:US
Practice Address - Phone:904-491-2111
Practice Address - Fax:904-512-0613
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-50382106S00000X
FLIMH13863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-18-50382OtherBACB