Provider Demographics
NPI:1891195145
Name:WARD, DOUGLAS R (BCBA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:WARD
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 1:6597 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-2521
Mailing Address - Country:US
Mailing Address - Phone:321-482-3525
Mailing Address - Fax:
Practice Address - Street 1:664 SEDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8034
Practice Address - Country:US
Practice Address - Phone:321-482-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-23
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-24573103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst