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1013578319
BENJAMIN JACOB FAGAN
LAKELAND, FL
NPI
1013578319
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103K00000X Behavior Analyst
Enumeration Date
2019-06-26
Last Update Date
2023-10-31
Business Address
BENJAMIN JACOB FAGAN
600 LAKE HOLLINGSWORTH DR
LAKELAND, FL 33803-2364
Phone number: 844-854-1116
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Mailing Address
BENJAMIN JACOB FAGAN
1500 S DOUGLAS RD STE 230
CORAL GABLES, FL 33134-4108
Phone number: 844-244-1818
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