Provider Demographics
NPI:1790251965
Name:JANICK, ELIZABETH (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JANICK
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1428
Mailing Address - Country:US
Mailing Address - Phone:401-618-6991
Mailing Address - Fax:
Practice Address - Street 1:715 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1428
Practice Address - Country:US
Practice Address - Phone:401-618-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILBA00154103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILBA00154OtherLBA
1-18-32291OtherBCBA