Provider Demographics
NPI:1689333189
Name:CHANCEY, JULIA M (BCABA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:CHANCEY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:DOERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:1509 E COLONIAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4729
Mailing Address - Country:US
Mailing Address - Phone:407-317-5429
Mailing Address - Fax:321-800-7201
Practice Address - Street 1:3910 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1290
Practice Address - Country:US
Practice Address - Phone:407-317-5429
Practice Address - Fax:321-800-7201
Is Sole Proprietor?:No
Enumeration Date:2021-12-12
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-22-14084106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112899700Medicaid