MEDICARE: MR. ROWLAND BEOKU-BETTS BEHAVIOR TECHNICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1508475641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROWLAND BEOKU-BETTS BEHAVIOR TECHNICIAN

Provider Business Mailing Address
First Line	:	246 BRUCKNER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-2175
Country	:	US
Telephone Number	:	917-359-4816
Fax Number	:

Provider Business Practice Location Address
First Line	:	458 MIDLAND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-5109
Country	:	US
Telephone Number	:	917-359-4816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	07/24/2020

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