Provider Demographics
NPI:1689472953
Name:PAGE, JA-NIYYAH CA-LEEAH HELEN
Entity type:Individual
Prefix:
First Name:JA-NIYYAH
Middle Name:CA-LEEAH HELEN
Last Name:PAGE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4325
Mailing Address - Country:US
Mailing Address - Phone:410-541-1316
Mailing Address - Fax:
Practice Address - Street 1:1517 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4325
Practice Address - Country:US
Practice Address - Phone:410-541-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician