Provider Demographics
NPI:1003575101
Name:SAFRANEK, REBECCA V
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:V
Last Name:SAFRANEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 OLD WILLETS PATH
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4124
Mailing Address - Country:US
Mailing Address - Phone:631-332-9319
Mailing Address - Fax:
Practice Address - Street 1:4250 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5338
Practice Address - Country:US
Practice Address - Phone:516-640-0798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst