Provider Demographics
NPI:1376094052
Name:REEVES-WOODRUFF, JONI LEE (BCBA)
Entity type:Individual
Prefix:MS
First Name:JONI
Middle Name:LEE
Last Name:REEVES-WOODRUFF
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 1:28091 WHITE DOVE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-7175
Mailing Address - Country:US
Mailing Address - Phone:856-503-8004
Mailing Address - Fax:
Practice Address - Street 1:5814 OLD PASCO RD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4011
Practice Address - Country:US
Practice Address - Phone:908-938-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-23294103K00000X
1-16-23294103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0409421Medicaid