Provider Demographics
NPI:1427395987
Name:BLASZAK, REBECCA (BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BLASZAK
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 1:533 ASTER AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501
Mailing Address - Country:US
Mailing Address - Phone:727-272-2242
Mailing Address - Fax:
Practice Address - Street 1:8108 SE COCONUT ST
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-4008
Practice Address - Country:US
Practice Address - Phone:855-832-8727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB422733825590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst