Provider Demographics
NPI:1477176295
Name:LOVE, JODIE (MSC, BCBA)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:MSC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 SANTA CRUZ WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4484
Mailing Address - Country:US
Mailing Address - Phone:786-865-8166
Mailing Address - Fax:
Practice Address - Street 1:4000 HOLLYWOOD BLVD STE 5000-S
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6751
Practice Address - Country:US
Practice Address - Phone:954-400-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ11726918103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst