Provider Demographics
NPI:1699463976
Name:REBELLO, REBECCA (BCBA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:REBELLO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STONY HILL ROAD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801
Mailing Address - Country:US
Mailing Address - Phone:860-946-0362
Mailing Address - Fax:
Practice Address - Street 1:24 STONY HILL ROAD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801
Practice Address - Country:US
Practice Address - Phone:860-946-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-23-64755103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst