Provider Demographics
NPI:1275359168
Name:REN, FANGCHI (BCBA, LBA-NY)
Entity type:Individual
Prefix:
First Name:FANGCHI
Middle Name:
Last Name:REN
Suffix:
Gender:F
Credentials:BCBA, LBA-NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-1250
Mailing Address - Country:US
Mailing Address - Phone:516-233-0155
Mailing Address - Fax:
Practice Address - Street 1:167 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1250
Practice Address - Country:US
Practice Address - Phone:516-233-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003921103K00000X
1-24-76863103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst