Provider Demographics
NPI:1063031128
Name:MAIRAJUDDIN, REHAN (BCBA)
Entity Type:Individual
Prefix:MR
First Name:REHAN
Middle Name:
Last Name:MAIRAJUDDIN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 WESTPOINTE BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8758
Mailing Address - Country:US
Mailing Address - Phone:407-205-7735
Mailing Address - Fax:
Practice Address - Street 1:7065 WESTPOINTE BLVD STE 307
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8758
Practice Address - Country:US
Practice Address - Phone:407-205-7735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001648103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst