Provider Demographics
NPI:1497400287
Name:ROGER WILLIAMS ACADEMY
Entity type:Organization
Organization Name:ROGER WILLIAMS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:713-859-6709
Mailing Address - Street 1:7447 CAMBRIDGE ST APT 47
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2027
Mailing Address - Country:US
Mailing Address - Phone:225-394-5997
Mailing Address - Fax:
Practice Address - Street 1:7447 CAMBRIDGE ST APT 47
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2027
Practice Address - Country:US
Practice Address - Phone:225-394-5997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-20
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty