Provider Demographics
NPI:1598360810
Name:EWART, CASEY (BCBA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:EWART
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:TOULOUKIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
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 1:2868 MAHAN DR
Practice Address - Street 2:UNIT 25, 26, 27
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-391-6060
Practice Address - Fax:850-692-6206
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-23-63805103K00000X
INRBT-20-141485106S00000X
FL1-23-63805103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician