Provider Demographics
NPI:1013151240
Name:ROBISON, KERI DAWN (BCABA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:DAWN
Last Name:ROBISON
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 1:6314 CORPORATE CT STE B
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3516
Mailing Address - Country:US
Mailing Address - Phone:239-690-5200
Mailing Address - Fax:239-690-5202
Practice Address - Street 1:6314 CORPORATE CT STE B
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3516
Practice Address - Country:US
Practice Address - Phone:239-690-5200
Practice Address - Fax:239-690-5202
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0020551103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst