Provider Demographics
NPI:1508475641
Name:BEOKU-BETTS, ROWLAND (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:ROWLAND
Middle Name:
Last Name:BEOKU-BETTS
Suffix:
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 BRUCKNER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2175
Mailing Address - Country:US
Mailing Address - Phone:917-359-4816
Mailing Address - Fax:
Practice Address - Street 1:458 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5109
Practice Address - Country:US
Practice Address - Phone:917-359-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst