Provider Demographics
NPI:1801122817
Name:MCDONALD, JOHANNA (BCBA)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:MCDONALD
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 1:1634 FERRIS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1810
Mailing Address - Country:US
Mailing Address - Phone:407-575-4236
Mailing Address - Fax:407-893-5892
Practice Address - Street 1:1634 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1810
Practice Address - Country:US
Practice Address - Phone:407-575-4236
Practice Address - Fax:407-893-5892
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01-0509103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01-0509OtherBEHAVIOR ANALYST CERTIFICATION BOARD