Provider Demographics
NPI:1679072599
Name:SRAGOW, REBECCA (BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SRAGOW
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 1:507 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3005
Mailing Address - Country:US
Mailing Address - Phone:609-760-4276
Mailing Address - Fax:
Practice Address - Street 1:2050 VOORHEES TOWN CTR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1910
Practice Address - Country:US
Practice Address - Phone:855-852-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician