Healthcare Provider Details

I. General information

NPI: 1881356533
Provider Name (Legal Business Name): JAVANNI HARVEY RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MARKET ST STE 119
YOUNGSTOWN OH
44512-2616
US

IV. Provider business mailing address

436 EARL DR NW
WARREN OH
44483-1116
US

V. Phone/Fax

Practice location:
  • Phone: 330-991-9117
  • Fax:
Mailing address:
  • Phone: 330-240-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71198
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-174700
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: