Provider Demographics
NPI:1093059669
Name:LOGUNOVSKIY, REBECCA (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LOGUNOVSKIY
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 RIDGEDALE AVE STE J
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1764
Mailing Address - Country:US
Mailing Address - Phone:973-515-1216
Mailing Address - Fax:973-515-3108
Practice Address - Street 1:171 RIDGEDALE AVE STE J
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1764
Practice Address - Country:US
Practice Address - Phone:973-515-1216
Practice Address - Fax:973-515-3108
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005878101YM0800X
NJ37PC00522600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health