MEDICARE: DEIRDRE HUMPHREY

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1659075117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE HUMPHREY

Provider Business Mailing Address
First Line	:	6214 24TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 W 21ST ST
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-2831
Country	:	US
Telephone Number	:	785-727-3473
Fax Number	:

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

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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Directions to “ DEIRDRE HUMPHREY ” Practice Location

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