Provider Demographics
NPI:1689190282
Name:GREEN, ASHLEY MERCER (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MERCER
Last Name:GREEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LAUREN
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 CANAL BLVD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3607
Practice Address - Country:US
Practice Address - Phone:904-834-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-23-64266103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty