Provider Demographics
NPI:1174078406
Name:COPES, JUDITH G (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:G
Last Name:COPES
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:G
Other - Last Name:RAMSDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1808 SENTRY OAK CT
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-3762
Mailing Address - Country:US
Mailing Address - Phone:904-923-9179
Mailing Address - Fax:
Practice Address - Street 1:3525 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7122
Practice Address - Country:US
Practice Address - Phone:904-297-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AL2020-016103K00000X
FL1-18-29344103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19268700Medicaid