Provider Demographics
NPI:1922241413
Name:DEKER, M. KEELY ROSEDALE (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:M. KEELY
Middle Name:ROSEDALE
Last Name:DEKER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MRS
Other - First Name:MEREDITH
Other - Middle Name:KEELY
Other - Last Name:ROSEDALE DEKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:4512 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1373
Mailing Address - Country:US
Mailing Address - Phone:407-295-0189
Mailing Address - Fax:
Practice Address - Street 1:848 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7699
Practice Address - Country:US
Practice Address - Phone:407-678-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-02-0847103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst