Provider Demographics
NPI:1851855571
Name:ROCKWELL, RENE ELIZABETH (MED BCBA)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:ELIZABETH
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61139 AZANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:CA
Mailing Address - Zip Code:92282-2709
Mailing Address - Country:US
Mailing Address - Phone:843-812-2665
Mailing Address - Fax:
Practice Address - Street 1:73321 FRED WARING DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2887
Practice Address - Country:US
Practice Address - Phone:760-525-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-33974103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst