Provider Demographics
NPI:1043369226
Name:LAPIDUS, REBECCA BLOCK (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:BLOCK
Last Name:LAPIDUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PETROL PT
Mailing Address - Street 2:SUITE D
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1550
Mailing Address - Country:US
Mailing Address - Phone:404-372-0024
Mailing Address - Fax:
Practice Address - Street 1:111 PETROL PT
Practice Address - Street 2:SUITE D
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1550
Practice Address - Country:US
Practice Address - Phone:404-372-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGRTMedicare ID - Type Unspecified
GA889865191AMedicare ID - Type Unspecified