Provider Demographics
NPI:1023271517
Name:CHANDLER, MERRILL MARTIN (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MERRILL
Middle Name:MARTIN
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:MERRILL
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4443 BASS PL N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6000
Mailing Address - Country:US
Mailing Address - Phone:904-465-0090
Mailing Address - Fax:904-212-1032
Practice Address - Street 1:4443 BASS PL N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6000
Practice Address - Country:US
Practice Address - Phone:904-465-0090
Practice Address - Fax:904-212-1032
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-06-3045103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017637000Medicaid
FL019880600Medicaid