Provider Demographics
NPI:1922735364
Name:BROKAW, RACHEL L (BCBA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:BROKAW
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 1:10 CLOVER HILL LN
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1005
Mailing Address - Country:US
Mailing Address - Phone:917-881-8885
Mailing Address - Fax:
Practice Address - Street 1:10 CLOVER HILL LN
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1005
Practice Address - Country:US
Practice Address - Phone:917-881-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-22-60542103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst