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NPI Code Detail

MEDICARE: DIANA ELAINE HAFELY RBT, BCABA

MEDICARE: DIANA ELAINE HAFELY RBT, BCABA
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
1106S00000XBehavior TechnicianRBT-16-24378OH
2106E00000XAssistant Behavior Analyst0-20-10735OH

General Provider Information

NPI Number : 1740899038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA ELAINE HAFELY RBT, BCABA
Provider Business Mailing Address
First Line : 1704 NORTH RD SE STE 2
Second Line :
City : WARREN
State : OH
Zip : 44484-2958
Country : US
Telephone Number : 330-856-4111
Fax Number :
Provider Business Practice Location Address
First Line : 1704 NORTH RD SE STE 2
Second Line :
City : WARREN
State : OH
Zip : 44484-2958
Country : US
Telephone Number : 330-856-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2020
Last Update Date : 07/23/2020

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