Individual provider Active NPI

Breanne Baez-Colantonio, MS, BCBA

  • Behavior Analyst
  • Melbourne, FL
National Provider Identifier
1972955086
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-18-32565 Issued in FL
Practice address
125 E Nasa Blvd
Melbourne, FL 32901
Phone
(321) 372-6813
Fax
(321) 765-6434
NPI assigned
Jul 13, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-17-41823
Behavior Analyst 103K00000X 1-18-32565 FL Primary

Addresses

Primary practice location

125 E Nasa Blvd
Melbourne, FL 32901

Mailing address

125 E Nasa Blvd
Melbourne, FL 32901-1900
Phone (321) 372-6813

Other practice location 1

150 W University Blvd
Melbourne, FL 32901-6982
Phone (321) 674-8106

Other practice location 2

1855 W Hibiscus Blvd
Melbourne, FL 32901-2622
Phone (321) 265-4409

Other practice location 3

2180 Julian Ave NE
Palm Bay, FL 32905-4020
Phone (321) 372-6813

Other identifiers 1

IdentifierTypeStateIssuer
022112800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Kaleidoscope Interventions Behavior Analyst Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1972955086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 E NASA BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011900",
            "telephone_number": "321-372-6813",
            "fax_number": "321-765-6434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E NASA BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901",
            "telephone_number": "321-372-6813",
            "fax_number": "321-765-6434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 W University Blvd",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329016982",
            "country_code": "US",
            "telephone_number": "321-674-8106",
            "fax_number": "321-674-8411",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1855 W Hibiscus Blvd",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329012622",
            "country_code": "US",
            "telephone_number": "321-265-4409",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2180 Julian Ave NE",
            "address_purpose": "LOCATION",
            "city": "Palm Bay",
            "state": "FL",
            "postal_code": "329054020",
            "country_code": "US",
            "telephone_number": "321-372-6813",
            "fax_number": "321-764-6434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAEZ-COLANTONIO",
        "first_name": "BREANNE",
        "credential": "MS, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-13",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": "RBT-17-41823",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-18-32565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022112800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; 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.