Provider Demographics
NPI:1447543350
Name:BRATON, CASSIDY (BCABA)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:BRATON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7990 W HOMOSASSA TRL
Mailing Address - Street 2:UNIT #2
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-2892
Mailing Address - Country:US
Mailing Address - Phone:352-621-0502
Mailing Address - Fax:352-621-0503
Practice Address - Street 1:7990 W HOMOSASSA TRL
Practice Address - Street 2:UNIT #2
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2892
Practice Address - Country:US
Practice Address - Phone:352-621-0502
Practice Address - Fax:352-621-0503
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0051709103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0051709OtherBEHAVIOR ANALYST CERTIFICATION BOARD, INC