Provider Demographics
NPI:1043800493
Name:REBECCA ANDERSON PHD LLC
Entity Type:Organization
Organization Name:REBECCA ANDERSON PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-351-5979
Mailing Address - Street 1:2197 PINE WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2543
Mailing Address - Country:US
Mailing Address - Phone:413-246-5499
Mailing Address - Fax:
Practice Address - Street 1:9210 ESTERO PARK COMMONS BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6395
Practice Address - Country:US
Practice Address - Phone:239-351-5979
Practice Address - Fax:259-495-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538104302OtherNPI - TYPE 1