Provider Demographics
NPI:1205346178
Name:THAMPAN, RACHEL (MA, BCBA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:THAMPAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DYNASTY DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4012
Mailing Address - Country:US
Mailing Address - Phone:302-256-6471
Mailing Address - Fax:
Practice Address - Street 1:908 CHURCHMANS ROAD EXT STE B
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3109
Practice Address - Country:US
Practice Address - Phone:302-323-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-01-0674103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst