Provider Demographics
NPI:1003399627
Name:BURKEY, REBEKAH JAYNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:JAYNE
Last Name:BURKEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:JAYNE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:4 S KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7418
Mailing Address - Country:US
Mailing Address - Phone:978-521-6868
Mailing Address - Fax:978-521-1965
Practice Address - Street 1:4 S KIMBALL ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7418
Practice Address - Country:US
Practice Address - Phone:978-521-6868
Practice Address - Fax:978-521-1965
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1196831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical