Provider Demographics
NPI:1255809232
Name:SALAMAN BIRD, HARRY (BCBA)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:SALAMAN BIRD
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-2131
Mailing Address - Country:US
Mailing Address - Phone:407-452-2536
Mailing Address - Fax:407-483-9551
Practice Address - Street 1:2301 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4124
Practice Address - Country:US
Practice Address - Phone:407-452-2536
Practice Address - Fax:321-219-8680
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL12043226103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-20-43226OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD
FL021658300Medicaid
FL1-20-43226OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD