Provider Demographics
NPI:1639697964
Name:GOLDBERG, RACHEL TOVA (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:TOVA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11907 HUNTING TWEED DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1528
Mailing Address - Country:US
Mailing Address - Phone:857-231-6728
Mailing Address - Fax:
Practice Address - Street 1:11907 HUNTING TWEED DR.
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:857-231-6728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11726665103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst