Provider Demographics
NPI:1235389065
Name:EARLS, JUDITH (BCBA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:EARLS
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 1:4820 KERRY FOREST PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-0201
Mailing Address - Country:US
Mailing Address - Phone:850-521-0242
Mailing Address - Fax:850-521-1973
Practice Address - Street 1:4820 KERRY FOREST PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-0200
Practice Address - Country:US
Practice Address - Phone:850-521-0242
Practice Address - Fax:850-521-1973
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL1-01-0586103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst