Provider Demographics
NPI:1265261598
Name:BESAW, KHARYNAH
Entity type:Individual
Prefix:
First Name:KHARYNAH
Middle Name:
Last Name:BESAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 NW 46TH AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4257
Mailing Address - Country:US
Mailing Address - Phone:413-368-6079
Mailing Address - Fax:
Practice Address - Street 1:2029 NW 46TH AVE APT 403
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-4257
Practice Address - Country:US
Practice Address - Phone:413-368-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician