Provider Demographics
NPI:1750819520
Name:BAER SCHIMKUS, PRISCILLA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:BAER SCHIMKUS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E AVENUE C
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1334
Mailing Address - Country:US
Mailing Address - Phone:321-427-3191
Mailing Address - Fax:
Practice Address - Street 1:1051 EBER BLVD STE 108
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8768
Practice Address - Country:US
Practice Address - Phone:321-536-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-16-7511106E00000X
1-20-40532103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-40532OtherBOARD CERTIFIED BEHAVIOR ANALYST
0-16-7511OtherBOARD CERTIFIED ASSISTANT BEHAVIOR ANALYST