Provider Demographics
NPI:1225654247
Name:RAUCHBACH, LEIA LYN (BCBA)
Entity Type:Individual
Prefix:
First Name:LEIA
Middle Name:LYN
Last Name:RAUCHBACH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ANN ST
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1905
Mailing Address - Country:US
Mailing Address - Phone:201-317-4577
Mailing Address - Fax:
Practice Address - Street 1:13 ANN ST
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1905
Practice Address - Country:US
Practice Address - Phone:201-317-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-20-42342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst