Provider Demographics
NPI:1396598694
Name:ELLERBEE, RAHEIM HENRY-MISHAWNE
Entity type:Individual
Prefix:
First Name:RAHEIM
Middle Name:HENRY-MISHAWNE
Last Name:ELLERBEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-1502
Mailing Address - Country:US
Mailing Address - Phone:631-612-1170
Mailing Address - Fax:
Practice Address - Street 1:207 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-1502
Practice Address - Country:US
Practice Address - Phone:631-612-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician