Provider Demographics
NPI:1871287490
Name:CREECH, CASSANDRA DANIELLE (RBT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:DANIELLE
Last Name:CREECH
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 1:11050 NE 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:FL
Mailing Address - Zip Code:32617-3048
Mailing Address - Country:US
Mailing Address - Phone:810-706-2310
Mailing Address - Fax:
Practice Address - Street 1:5830 US HIGHWAY 1 STE 104
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5704
Practice Address - Country:US
Practice Address - Phone:321-609-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-277285106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician