Provider Demographics
NPI:1851808398
Name:VON BARNAU SYTHOFF, JAMIE P (BCABA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:P
Last Name:VON BARNAU SYTHOFF
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 SCENIC OAK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-4911
Mailing Address - Country:US
Mailing Address - Phone:850-598-5887
Mailing Address - Fax:
Practice Address - Street 1:15 10TH AVE
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1340
Practice Address - Country:US
Practice Address - Phone:850-607-6932
Practice Address - Fax:850-607-6932
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-42300106S00000X
24-15054103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician