Provider Demographics
NPI:1801223169
Name:ALTRO, THOMAS A (BCBA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:ALTRO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MIDDLE ST
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3625
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:866-610-0580
Practice Address - Street 1:515 PALM COAST PKWY SW
Practice Address - Street 2:SUITE 6/7
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4739
Practice Address - Country:US
Practice Address - Phone:386-951-3044
Practice Address - Fax:866-610-0580
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22260103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst