Provider Demographics
NPI:1104712447
Name:PEVZNER, IRIS MAE (RBT)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:MAE
Last Name:PEVZNER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1578
Mailing Address - Country:US
Mailing Address - Phone:781-424-9877
Mailing Address - Fax:
Practice Address - Street 1:160 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-1578
Practice Address - Country:US
Practice Address - Phone:781-424-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARBT-24-394096106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician