Provider Demographics
NPI:1558658039
Name:RAMBO, RONALD J (MED BCBA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:RAMBO
Suffix:
Gender:M
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 THREE OAKS CT
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-8953
Mailing Address - Country:US
Mailing Address - Phone:803-271-2533
Mailing Address - Fax:
Practice Address - Street 1:139 THREE OAKS CT
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-8953
Practice Address - Country:US
Practice Address - Phone:803-271-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-11-9034103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst