Provider Demographics
NPI:1588180657
Name:ELLIOTT, ANDREA (BCABA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 SUGARBLUFF RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-6819
Mailing Address - Country:US
Mailing Address - Phone:352-223-1999
Mailing Address - Fax:352-600-3119
Practice Address - Street 1:355 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6501
Practice Address - Country:US
Practice Address - Phone:352-223-1999
Practice Address - Fax:352-600-3119
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst