Provider Demographics
NPI:1972806040
Name:JUN, ZHUANG (BCBA)
Entity Type:Individual
Prefix:MR
First Name:ZHUANG
Middle Name:
Last Name:JUN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:
Other - Last Name:ZHUANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:161 ROSETTE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-7123
Mailing Address - Country:US
Mailing Address - Phone:407-327-9987
Mailing Address - Fax:407-327-9987
Practice Address - Street 1:161 ROSETTE DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-7123
Practice Address - Country:US
Practice Address - Phone:407-327-9987
Practice Address - Fax:407-327-9987
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-00-0306103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679101898Medicaid
FL679101896Medicaid