Provider Demographics
NPI:1013791326
Name:PAIGE, JERRICCA DARLENE (RBT)
Entity Type:Individual
Prefix:
First Name:JERRICCA
Middle Name:DARLENE
Last Name:PAIGE
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 1:1071 TAMWORTH LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-8459
Mailing Address - Country:US
Mailing Address - Phone:502-219-5743
Mailing Address - Fax:
Practice Address - Street 1:2634 NEBLETT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4952
Practice Address - Country:US
Practice Address - Phone:502-219-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-23-256252106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician