Provider Demographics
NPI:1629594551
Name:DION, BREANA MICHELINA
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:MICHELINA
Last Name:DION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 NEWCASTLE CT APT 206
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-4165
Mailing Address - Country:US
Mailing Address - Phone:727-331-7292
Mailing Address - Fax:
Practice Address - Street 1:3653 NEWCASTLE CT APT 206
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-4165
Practice Address - Country:US
Practice Address - Phone:727-331-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty