Provider Demographics
NPI:1700494879
Name:JUSTIN, BETSAIDA
Entity Type:Individual
Prefix:
First Name:BETSAIDA
Middle Name:
Last Name:JUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1889 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5657
Mailing Address - Country:US
Mailing Address - Phone:561-229-6606
Mailing Address - Fax:
Practice Address - Street 1:1889 ABBEY RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-5657
Practice Address - Country:US
Practice Address - Phone:561-229-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician