Provider Demographics
NPI:1366793598
Name:MURRAY, MANDY (BCBA)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:MURRAY
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 1:6289 PARADISE ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6962
Mailing Address - Country:US
Mailing Address - Phone:407-619-5570
Mailing Address - Fax:
Practice Address - Street 1:6289 PARADISE ISLAND CT
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6962
Practice Address - Country:US
Practice Address - Phone:407-619-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL1-15-20120103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst