Provider Demographics
NPI:1336932540
Name:REITANO, REBECCA (RBT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:REITANO
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 1:31 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1320
Mailing Address - Country:US
Mailing Address - Phone:267-259-1084
Mailing Address - Fax:
Practice Address - Street 1:2 PIN OAK LN STE 250
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1630
Practice Address - Country:US
Practice Address - Phone:856-669-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBACB1138121106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician