Provider Demographics
NPI:1730902545
Name:HERARD, AQUINNAH PIERRE
Entity type:Individual
Prefix:
First Name:AQUINNAH
Middle Name:PIERRE
Last Name:HERARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 N 73RD WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5506
Mailing Address - Country:US
Mailing Address - Phone:954-624-2321
Mailing Address - Fax:
Practice Address - Street 1:1230 N 73RD WAY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5506
Practice Address - Country:US
Practice Address - Phone:954-624-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-385696106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician