Provider Demographics
NPI:1922657519
Name:FITZGERALD, DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:FITZGERALD
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 1:80 COLLEGE BLVD E
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1343
Mailing Address - Country:US
Mailing Address - Phone:850-279-3000
Mailing Address - Fax:850-389-2269
Practice Address - Street 1:103 RICKEY AVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2520
Practice Address - Country:US
Practice Address - Phone:850-376-5624
Practice Address - Fax:850-937-7381
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11301106E00000X
FLRBT-17-42385106S00000X
FL1-23-67761103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician