1376125401 NPI number — BETHANY ROSE GIOKAS MS. ED., BCBA, LABA

Table of content: BETHANY ROSE GIOKAS MS. ED., BCBA, LABA (NPI 1376125401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376125401 NPI number — BETHANY ROSE GIOKAS MS. ED., BCBA, LABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIOKAS
Provider First Name:
BETHANY
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS. ED., BCBA, LABA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRAVITZ
Provider Other First Name:
BETHANY
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS. ED, BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376125401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 UNION ST APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01845-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-667-7449
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 UNION ST APT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01845-3423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-667-7449
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  980721 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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