Provider Demographics
NPI:1386897551
Name:ANITA K REBHAN, BCBA, INC.
Entity type:Organization
Organization Name:ANITA K REBHAN, BCBA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:REBAHN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-733-9746
Mailing Address - Street 1:2715 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7519
Mailing Address - Country:US
Mailing Address - Phone:561-733-9746
Mailing Address - Fax:561-736-1581
Practice Address - Street 1:2715 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7519
Practice Address - Country:US
Practice Address - Phone:561-733-9746
Practice Address - Fax:561-736-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682763296Medicaid