Provider Demographics
NPI:1043709272
Name:DRAKE, CHERYL (RBT)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125D JOSEPH LONSWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:13624-9585
Mailing Address - Country:US
Mailing Address - Phone:908-763-0297
Mailing Address - Fax:
Practice Address - Street 1:125D JOSEPH LONSWAY DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624-9585
Practice Address - Country:US
Practice Address - Phone:908-763-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician