Provider Demographics
NPI:1619378684
Name:NEWMAN, REBECCA N (BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:NEWMAN
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 1:101 W DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1915
Mailing Address - Country:US
Mailing Address - Phone:260-489-1774
Mailing Address - Fax:260-489-1777
Practice Address - Street 1:101 W DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1915
Practice Address - Country:US
Practice Address - Phone:260-489-1774
Practice Address - Fax:260-489-1777
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst