Provider Demographics
NPI:1902531353
Name:ASKEN, BRETON (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:BRETON
Middle Name:
Last Name:ASKEN
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100165 UNIVERSITY OF FLORIDA - COLLEGE OF PHHP
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0001
Mailing Address - Country:US
Mailing Address - Phone:352-273-6617
Mailing Address - Fax:
Practice Address - Street 1:3009 SW WILLISTON RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3928
Practice Address - Country:US
Practice Address - Phone:352-294-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11512103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BOC220124OtherNATIONAL ATHLETIC TRAINERS' ASSOCIATION BOARD OF CERTIFICATION
FLPY11512OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH
FL116325900Medicaid