Provider Demographics
NPI:1821830118
Name:BLEW, JOSIE L (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:L
Last Name:BLEW
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 RESTING ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-2997
Mailing Address - Country:US
Mailing Address - Phone:407-686-9089
Mailing Address - Fax:
Practice Address - Street 1:3838 RESTING ROBIN AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-2997
Practice Address - Country:US
Practice Address - Phone:407-686-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-355316106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician