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NPI 1760970701

NPI 1760970701 : REBECCA ANNE MANCINI BCBA : PALATINE, IL

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General NPI Number Information
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    NPI Number           |    1760970701
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    Entity Type          |    Individual 
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    Provider Name        |    REBECCA ANNE MANCINI BCBA
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    04/25/2018
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    Last Update Date     |    04/25/2018
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Provider Practice Location Address
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    Address Line         |    24 W STATION ST UNIT 415 
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    City                 |    PALATINE
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    State                |    IL
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    Zip                  |    60067-7603
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    Country              |    US
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    Telephone            |    847-343-3587
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    24 W STATION ST UNIT 415 
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    City                 |    PALATINE
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    State                |    IL
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    Zip                  |    60067-7603
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    103K00000X
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    Taxonomy Name        |    Behavior Analyst
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    License Number       |    11624307
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    License Number State |    
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Taxonomy #2
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    Taxonomy Code        |    103K00000X
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    Taxonomy Name        |    Behavior Analyst
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    License Number       |    11624307
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    License Number State |    FL
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Taxonomy #3
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    Taxonomy Code        |    103K00000X
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    Taxonomy Name        |    Behavior Analyst
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    License Number       |    1-16-24307
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    License Number State |    
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