Healthcare Provider Details

I. General information

NPI: 1316482359
Provider Name (Legal Business Name): LENA ELIZABETH NEWBORN R.B.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 HOUGH RD
FLORENCE AL
35630-1747
US

IV. Provider business mailing address

2624 HOUGH RD
FLORENCE AL
35630-1747
US

V. Phone/Fax

Practice location:
  • Phone: 256-275-7089
  • Fax:
Mailing address:
  • Phone: 256-275-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-27582
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: