Healthcare Provider Details

I. General information

NPI: 1881185619
Provider Name (Legal Business Name): REBECCA BAKER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 ADANSON ST
ORLANDO FL
32804-1331
US

IV. Provider business mailing address

5165 ADANSON ST
ORLANDO FL
32804-1331
US

V. Phone/Fax

Practice location:
  • Phone: 407-408-7402
  • Fax: 407-627-0303
Mailing address:
  • Phone: 407-408-7402
  • Fax: 407-627-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: