Provider Demographics
NPI:1508150962
Name:MANION, BROOKE MICHELE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MICHELE
Last Name:MANION
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 1:2475 PLUMADORE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9012
Mailing Address - Country:US
Mailing Address - Phone:321-279-2443
Mailing Address - Fax:352-602-4142
Practice Address - Street 1:10726 LIBBY NUMBER 3 RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-8734
Practice Address - Country:US
Practice Address - Phone:352-508-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-08-4433103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst