Provider Demographics
NPI:1114404027
Name:GRULER, RACHEL (BCBA LP-LBA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GRULER
Suffix:
Gender:F
Credentials:BCBA LP-LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3554
Mailing Address - Country:US
Mailing Address - Phone:765-721-2234
Mailing Address - Fax:
Practice Address - Street 1:587 MAIN ST
Practice Address - Street 2:2
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1175
Practice Address - Country:US
Practice Address - Phone:765-721-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-30568103K00000X
NYP11777103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst