Provider Demographics
NPI:1548402001
Name:STORMS, JACQUELINE S (BS, BCABA)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:S
Last Name:STORMS
Suffix:
Gender:F
Credentials:BS, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5729 CROWNTREE LN APT LANE
Mailing Address - Street 2:APARTMENT #303 BUILDING 11
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8041
Mailing Address - Country:US
Mailing Address - Phone:407-310-6790
Mailing Address - Fax:407-601-1487
Practice Address - Street 1:5729 CROWNTREE LN APT LANE
Practice Address - Street 2:APARTMENT #303 BUILDING 11
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8041
Practice Address - Country:US
Practice Address - Phone:407-310-6790
Practice Address - Fax:407-601-1487
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-01-0389103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst