Provider Demographics
NPI:1427614072
Name:INEGBEDION, AUGUSTA IWARIA
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:IWARIA
Last Name:INEGBEDION
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 1:1647 NE 124TH LN
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2543
Mailing Address - Country:US
Mailing Address - Phone:202-813-6946
Mailing Address - Fax:
Practice Address - Street 1:1647 NE 124TH LN
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2543
Practice Address - Country:US
Practice Address - Phone:202-813-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-04-23106S00000X
FL1-24-76339103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician