Provider Demographics
NPI:1629850607
Name:CLOSSON, EVE ELIZABETH
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:ELIZABETH
Last Name:CLOSSON
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 1:2520 BROOKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6638
Mailing Address - Country:US
Mailing Address - Phone:321-446-5478
Mailing Address - Fax:
Practice Address - Street 1:2520 BROOKSHIRE CIR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-6638
Practice Address - Country:US
Practice Address - Phone:321-446-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician