Provider Demographics
NPI:1619632627
Name:ANDERSON, MILDRED FRANCES (RBT)
Entity Type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:FRANCES
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BAY SPRING PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-7305
Mailing Address - Country:US
Mailing Address - Phone:302-423-6775
Mailing Address - Fax:
Practice Address - Street 1:19 BAY SPRING PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-7305
Practice Address - Country:US
Practice Address - Phone:302-423-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-21-179355106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician