Provider Demographics
NPI:1386212025
Name:MERRITT, BROOKE (MED, BCBA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:407-915-7729
Mailing Address - Fax:407-588-6294
Practice Address - Street 1:535 RIVERSTONE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2566
Practice Address - Country:US
Practice Address - Phone:470-863-3100
Practice Address - Fax:470-648-1778
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-23-68865103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst