Provider Demographics
NPI:1407217821
Name:SEBAN, REBECCA B (MS ED, BCBA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:B
Last Name:SEBAN
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2C GOVERNORS WAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-5113
Mailing Address - Country:US
Mailing Address - Phone:508-838-8064
Mailing Address - Fax:
Practice Address - Street 1:2C GOVERNORS WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-5113
Practice Address - Country:US
Practice Address - Phone:508-838-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-14-15067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst