Provider Demographics
NPI:1558928481
Name:ULTZHOFFER, REBEKAH ANN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:ULTZHOFFER
Suffix:
Gender:F
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 1:5 MCNALLY ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1103
Mailing Address - Country:US
Mailing Address - Phone:908-514-1634
Mailing Address - Fax:
Practice Address - Street 1:1970 SWARTHMORE AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4553
Practice Address - Country:US
Practice Address - Phone:732-523-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-47671103K00000X, 103K00000X
NJ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician