Provider Demographics
NPI:1093434292
Name:GIARRUSSO, BETHANY ANNE (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:ANNE
Last Name:GIARRUSSO
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DRAWBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-5579
Mailing Address - Country:US
Mailing Address - Phone:401-206-9161
Mailing Address - Fax:
Practice Address - Street 1:715 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1428
Practice Address - Country:US
Practice Address - Phone:401-618-6991
Practice Address - Fax:401-618-6995
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILBA00312103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty