Provider Demographics
NPI:1508385923
Name:PANKIN, RACHEL KATYA (BCBA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:KATYA
Last Name:PANKIN
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 1:2425 BLUERIDGE AVE APT 171
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4560
Mailing Address - Country:US
Mailing Address - Phone:757-232-6986
Mailing Address - Fax:
Practice Address - Street 1:2425 BLUERIDGE AVE APT 171
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4560
Practice Address - Country:US
Practice Address - Phone:757-232-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000196106E00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst