Provider Demographics
NPI:1457059131
Name:AIDT, ARCHER DEAN
Entity Type:Individual
Prefix:
First Name:ARCHER
Middle Name:DEAN
Last Name:AIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:AIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 RANKIN WAY APT 10
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2110
Mailing Address - Country:US
Mailing Address - Phone:707-205-0617
Mailing Address - Fax:
Practice Address - Street 1:150 RANKIN WAY APT 10
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2110
Practice Address - Country:US
Practice Address - Phone:707-205-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician