Provider Demographics
NPI:1518250299
Name:DECHEONA PEARL, MAGALY D (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:D
Last Name:DECHEONA PEARL
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:D
Other - Last Name:PEARL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1478 SE LEGACY COVE CIR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7634
Mailing Address - Country:US
Mailing Address - Phone:772-240-8494
Mailing Address - Fax:
Practice Address - Street 1:1478 SE LEGACY COVE CIR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7634
Practice Address - Country:US
Practice Address - Phone:772-240-8494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-10-7165103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-10-7165OtherBOARD CERTIFIED BEHAVIOR ANALYST (BCB)