Healthcare Provider Details

I. General information

NPI: 1619743200
Provider Name (Legal Business Name): HANNAH RAE BOOTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MACKENAN DR
CARY NC
27511-7903
US

IV. Provider business mailing address

111 MACKENAN DR
CARY NC
27511-7903
US

V. Phone/Fax

Practice location:
  • Phone: 919-371-2848
  • Fax:
Mailing address:
  • Phone: 919-371-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4606
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: