Provider Demographics
NPI:1720479363
Name:TIBBETT, RENAE MARI (BCBA)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:MARI
Last Name:TIBBETT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:
Other - Last Name:OLIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:112 LARRABEE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-8697
Mailing Address - Country:US
Mailing Address - Phone:209-471-7962
Mailing Address - Fax:
Practice Address - Street 1:105 HMS STAYNER DR
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1664
Practice Address - Country:US
Practice Address - Phone:617-957-6451
Practice Address - Fax:781-385-7324
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB# 1-14-15715103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst