Healthcare Provider Details

I. General information

NPI: 1275111346
Provider Name (Legal Business Name): REBECCA JEAN ALLEN MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 PUTNAM PIKE
GREENVILLE RI
02828-1428
US

IV. Provider business mailing address

5 E BAYVIEW RD
CHARLESTOWN RI
02813-2000
US

V. Phone/Fax

Practice location:
  • Phone: 401-618-6991
  • Fax:
Mailing address:
  • Phone: 401-261-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00248
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: