Provider Demographics
NPI:1013244458
Name:CARON, BRIDGET J (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:J
Last Name:CARON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 FAIRWAY PARK BLVD UNIT 1008
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2623
Mailing Address - Country:US
Mailing Address - Phone:904-662-0289
Mailing Address - Fax:904-269-9667
Practice Address - Street 1:1409 KINGSLEY AVE STE 1C
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4532
Practice Address - Country:US
Practice Address - Phone:904-662-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1073630103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst