Provider Demographics
NPI:1487142113
Name:BERRYMAN, ROBERT A (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:BERRYMAN
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 ADDISON DR STE A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7065
Mailing Address - Country:US
Mailing Address - Phone:850-469-3726
Mailing Address - Fax:
Practice Address - Street 1:3355 ADDISON DR STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7065
Practice Address - Country:US
Practice Address - Phone:850-368-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-31216103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst