Provider Demographics
NPI:1821229295
Name:GROFF, REBECCA (BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GROFF
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:VEENSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12385 SORRENTO RD STE C3
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8656
Mailing Address - Country:US
Mailing Address - Phone:850-483-1508
Mailing Address - Fax:
Practice Address - Street 1:12385 SORRENTO RD STE C3
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8656
Practice Address - Country:US
Practice Address - Phone:850-483-1508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025287200Medicaid