Healthcare Provider Details

I. General information

NPI: 1699463976
Provider Name (Legal Business Name): REBECCA REBELLO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 CEDAR VALLEY WAY APT B3
HAMBURG NY
14075-3691
US

IV. Provider business mailing address

3385 CEDAR VALLEY WAY APT B3
HAMBURG NY
14075-3691
US

V. Phone/Fax

Practice location:
  • Phone: 475-237-2278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64755
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: