Provider Demographics
NPI:1326296450
Name:MUNDAY, REBECCA (EDS BCBA LBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MUNDAY
Suffix:
Gender:F
Credentials:EDS BCBA LBA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:CUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1728
Mailing Address - Country:US
Mailing Address - Phone:860-495-0126
Mailing Address - Fax:
Practice Address - Street 1:160 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-495-0126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-05-2581174400000X
CT562103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist