Provider Demographics
NPI:1023493335
Name:SHRINER, CARRIE A (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:A
Last Name:SHRINER
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 1:1611 SHERWOOD LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-6805
Mailing Address - Country:US
Mailing Address - Phone:863-370-4015
Mailing Address - Fax:
Practice Address - Street 1:5302 S FLORIDA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4922
Practice Address - Country:US
Practice Address - Phone:863-937-8067
Practice Address - Fax:863-607-6207
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-10264103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst