Provider Demographics
NPI:1508507864
Name:TRACY BEIN, LLC
Entity Type:Organization
Organization Name:TRACY BEIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:RUGGIERO
Authorized Official - Last Name:BEIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:808-283-9061
Mailing Address - Street 1:44 KANANI RD APT 3-201
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6716
Mailing Address - Country:US
Mailing Address - Phone:808-283-9061
Mailing Address - Fax:
Practice Address - Street 1:44 KANANI RD APT 3-201
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6716
Practice Address - Country:US
Practice Address - Phone:808-283-9061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI825755Medicaid