Provider Demographics
NPI:1780430413
Name:JANIS, REBECCA ANNE (RBT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:JANIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 TOTOWA RD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2745
Mailing Address - Country:US
Mailing Address - Phone:973-237-1975
Mailing Address - Fax:
Practice Address - Street 1:142 TOTOWA RD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2745
Practice Address - Country:US
Practice Address - Phone:973-237-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NJRBT-21-164444106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician