Provider Demographics
NPI:1174901607
Name:SEECHARAN, REGINALD SHANNON (BCABA)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:SHANNON
Last Name:SEECHARAN
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 JAMES CIR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5613
Mailing Address - Country:US
Mailing Address - Phone:321-961-7898
Mailing Address - Fax:
Practice Address - Street 1:700 JAMES CIR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905
Practice Address - Country:US
Practice Address - Phone:321-961-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-17
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-18414106S00000X
222Q00000X
CO0-17-7660106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist