Provider Demographics
NPI:1861721409
Name:STEWART, ANGELA ERICA (BCBA)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ERICA
Last Name:STEWART
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:PO BOX 24925
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-4925
Mailing Address - Country:US
Mailing Address - Phone:904-288-7259
Mailing Address - Fax:904-288-7260
Practice Address - Street 1:4674-2 HOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1114
Practice Address - Country:US
Practice Address - Phone:904-288-7259
Practice Address - Fax:904-288-7260
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-09-5888103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst