Provider Demographics
NPI:1235770173
Name:BABEK, REBECCA IRENE (BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:IRENE
Last Name:BABEK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:I
Other - Last Name:LACROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 PARK RD
Mailing Address - Street 2:
Mailing Address - City:IVORYTON
Mailing Address - State:CT
Mailing Address - Zip Code:06442-1228
Mailing Address - Country:US
Mailing Address - Phone:860-304-2543
Mailing Address - Fax:
Practice Address - Street 1:27 PARK RD
Practice Address - Street 2:
Practice Address - City:IVORYTON
Practice Address - State:CT
Practice Address - Zip Code:06442-1228
Practice Address - Country:US
Practice Address - Phone:860-304-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst