Provider Demographics
NPI:1891496196
Name:DERMAN, KAREISHA LYNN (RBT)
Entity Type:Individual
Prefix:
First Name:KAREISHA
Middle Name:LYNN
Last Name:DERMAN
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 1:305 TRABUE ST APT 231
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1391
Mailing Address - Country:US
Mailing Address - Phone:270-579-3472
Mailing Address - Fax:
Practice Address - Street 1:312 HURT ST UNIT C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-2311
Practice Address - Country:US
Practice Address - Phone:859-230-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBACB878508106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician