Basic Information
| Provider Information | |||||||||
| NPI: | 1427395987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLASZAK | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 533 ASTER AVE | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272722242 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8108 SE COCONUT ST | ||||||||
| Address2: | |||||||||
| City: | HOBE SOUND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334554008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558328727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2013 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | B422733825590 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.