Provider Demographics
NPI:1346961349
Name:KANTAWANG, TITIRAT
Entity Type:Individual
Prefix:
First Name:TITIRAT
Middle Name:
Last Name:KANTAWANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9823 HORACE HARDING EXPY APT 4J
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4253
Mailing Address - Country:US
Mailing Address - Phone:516-824-4788
Mailing Address - Fax:
Practice Address - Street 1:9823 HORACE HARDING EXPY APT 4J
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4253
Practice Address - Country:US
Practice Address - Phone:516-824-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst