Basic Information
| Provider Information | |||||||||
| NPI: | 1265564124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONSBERGER | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 E BAY CEDAR CIR | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614273711 | ||||||||
| FaxNumber: | 5618810972 | ||||||||
| Practice Location | |||||||||
| Address1: | 18370 LIMESTONE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334583860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613209520 | ||||||||
| FaxNumber: | 5613209495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 103K00000X | 1-04-2046 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 811665200 | 05 | FL | MEDICAID | 767558500 | 05 | FL | MEDICAID |