Avery Goodwin, BCABA

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

License

0-21-11965

Practice address

6810 Fort Jackson CT
Milton, FL 32583-7692

Phone

(850) 503-6636

Fax

(850) 626-6132

NPI assigned

Jan 27, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifelong Behavioral Services, LLC

  • Behavior Analyst
  • Milton, FL
  • NPI 1538679832
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1124659438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 FORT JACKSON CT",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325837692",
            "telephone_number": "850-503-6636",
            "fax_number": "850-626-6132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 FORT JACKSON CT",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325837692",
            "telephone_number": "850-503-6636",
            "fax_number": "850-626-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "AVERY",
        "credential": "BCABA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-27",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": "0-21-11965",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-20-110822",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia Katherina Glass, APRN
• Brayden Michael Glenn
• Jennfer A Godfrey, M.A. CCC/SLP
• Therese Eileen Goebel, PT
• Kaitlyn Goobeck
• Greater Pensacola Behavior Services Inc
• Jamie Greene, LMHC
• Shelby Ellis Grice, PA
• Gulf Coast Anesthesia Group PLLC
• Gulf Coast Physician Partners

• Assistant Behavior Analyst in Milton, FL
• Providers in Milton, FL by specialty
• Assistant Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.