1235403486 NPI number — RACHEL DELGADO MSED, BCBA, LBA

Table of content: RACHEL DELGADO MSED, BCBA, LBA (NPI 1235403486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235403486 NPI number — RACHEL DELGADO MSED, BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELGADO
Provider First Name:
RACHEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSED, BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235403486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7108 S KANNER HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34997-7462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-832-6727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5563 REDLEAF ROSE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29579-4478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-832-6727
Provider Business Practice Location Address Fax Number:
772-675-9100
Provider Enumeration Date:
03/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-12-10047 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 090063594 . This is a "CALIFORNIA COMMISSION ON TEACHER CREDENTIALING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 000453 . This is a "NYSED OFFICE OF THE PROFESSIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0133002835 . This is a "VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 837552 . This is a "NYS BOARD OF EDUCATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1-12-10047 . This is a "BACB" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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