MEDICARE: MS. REBECCA L JENDZEJEC MA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	LBA00130	RI

General Provider Information

NPI Number	:	1316444003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA L JENDZEJEC MA, BCBA

Provider Business Mailing Address
First Line	:	600 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2717
Country	:	US
Telephone Number	:	401-595-3773
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2717
Country	:	US
Telephone Number	:	401-595-3773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	10/24/2023

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