Provider Demographics
NPI:1659630101
Name:DAVIS, BARBARA JANINE (BCBA-D)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JANINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JANINE
Other - Last Name:TOMLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1790 SW 43RD WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5701
Mailing Address - Country:US
Mailing Address - Phone:855-442-2454
Mailing Address - Fax:954-206-7699
Practice Address - Street 1:1790 SW 43RD WAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33317-5701
Practice Address - Country:US
Practice Address - Phone:855-442-2454
Practice Address - Fax:954-206-7699
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA127103K00000X
FL1-10-6883103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021570000Medicaid