Provider Demographics
NPI:1194088526
Name:WRIGHT, REBECCA (MSED, BCBA, LBA)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137-42 134 AVE. FIRST FLOOR
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436
Mailing Address - Country:US
Mailing Address - Phone:616-375-0566
Mailing Address - Fax:
Practice Address - Street 1:137-42 134 AVE. FIRST FLOOR
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436
Practice Address - Country:US
Practice Address - Phone:616-375-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001267-1103K00000X
NY0012671171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171W00000XOther Service ProvidersContractor