Provider Demographics
NPI:1497530455
Name:LARSON, JUSTYNE DEENA (BCBA)
Entity Type:Individual
Prefix:
First Name:JUSTYNE
Middle Name:DEENA
Last Name:LARSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JUSTYNE
Other - Middle Name:DEENA
Other - Last Name:MCGETTIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:391 VILLA SORRENTO CIR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-8301
Mailing Address - Country:US
Mailing Address - Phone:208-660-6161
Mailing Address - Fax:
Practice Address - Street 1:941 W MORSE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3781
Practice Address - Country:US
Practice Address - Phone:561-513-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12366834103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst