Provider Demographics
NPI:1497484992
Name:DEW, CARLIE JANE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:CARLIE
Middle Name:JANE
Last Name:DEW
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 1:3705 SOUTHWIND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-3832
Mailing Address - Country:US
Mailing Address - Phone:405-985-2762
Mailing Address - Fax:
Practice Address - Street 1:520 POINTE PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0600
Practice Address - Country:US
Practice Address - Phone:405-805-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician