Provider Demographics
NPI:1376244384
Name:BIPRAM, KHEMWATTIE
Entity Type:Individual
Prefix:
First Name:KHEMWATTIE
Middle Name:
Last Name:BIPRAM
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 1:4897 CHACHA CT APT 70
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5670
Mailing Address - Country:US
Mailing Address - Phone:561-891-5587
Mailing Address - Fax:
Practice Address - Street 1:4897 CHACHA CT APT 70
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-5670
Practice Address - Country:US
Practice Address - Phone:561-891-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician