Healthcare Provider Details

I. General information

NPI: 1649846916
Provider Name (Legal Business Name): MRS. JUANITA MICHELLE OWUSU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUANITA M OWUSU MA, M.ED, BCBA

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 AUTUMNWOOD CT
DOVER DE
19904-1905
US

IV. Provider business mailing address

6 AUTUMNWOOD CT
DOVER DE
19904-1905
US

V. Phone/Fax

Practice location:
  • Phone: 302-760-3334
  • Fax:
Mailing address:
  • Phone: 302-760-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50146
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: