Provider Demographics
NPI:1215336698
Name:EMBACHER, REBECCA A (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:A
Last Name:EMBACHER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:KOSTYACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:CRS 10
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3815
Mailing Address - Country:US
Mailing Address - Phone:216-448-6037
Mailing Address - Fax:216-448-6445
Practice Address - Street 1:2801 MARTIN LUTHER KING JR DR
Practice Address - Street 2:CRS 10
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3815
Practice Address - Country:US
Practice Address - Phone:216-448-6037
Practice Address - Fax:216-448-6445
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH#34103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst