Provider Demographics
NPI:1982943049
Name:FISCHETTI, ANTHONY THOMAS (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:FISCHETTI
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:T
Other - Last Name:FISCHETTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:333 S ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2719
Mailing Address - Country:US
Mailing Address - Phone:585-766-2012
Mailing Address - Fax:
Practice Address - Street 1:685 KAREN DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6985
Practice Address - Country:US
Practice Address - Phone:321-431-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-9208103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU27706034Medicare UPIN