Provider Demographics
NPI:1518646066
Name:HARMON, KAITLYN BROOKS (RBT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:BROOKS
Last Name:HARMON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 CYPRESS GROVE DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-2503
Mailing Address - Country:US
Mailing Address - Phone:813-563-1322
Mailing Address - Fax:973-888-1377
Practice Address - Street 1:3209 CYPRESS GROVE DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-2503
Practice Address - Country:US
Practice Address - Phone:813-563-1322
Practice Address - Fax:973-888-1377
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician