Provider Demographics
NPI:1285969592
Name:BEIN, TRACY RUGGIERO (BCBA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:RUGGIERO
Last Name:BEIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:RUGGIERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 ALA MAKANI ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3507
Mailing Address - Country:US
Mailing Address - Phone:808-244-6879
Mailing Address - Fax:
Practice Address - Street 1:427 ALA MAKANI ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3507
Practice Address - Country:US
Practice Address - Phone:808-244-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst