Provider Demographics
NPI:1548714488
Name:LEWIS, JASON DAVID (BCBA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:LEWIS
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 1:2433 ACADEMY CIR E
Mailing Address - Street 2:APT 107
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8510
Mailing Address - Country:US
Mailing Address - Phone:484-225-6042
Mailing Address - Fax:
Practice Address - Street 1:831 IRMA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3806
Practice Address - Country:US
Practice Address - Phone:407-796-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-19589103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst