Provider Demographics
NPI:1558664912
Name:BOVINO-SANDQUIST, REBECCA JOANN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOANN
Last Name:BOVINO-SANDQUIST
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2441
Mailing Address - Country:US
Mailing Address - Phone:912-429-8774
Mailing Address - Fax:
Practice Address - Street 1:118 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2441
Practice Address - Country:US
Practice Address - Phone:912-429-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst