Provider Demographics
NPI:1093184301
Name:DEFINBAUGH, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DEFINBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 HORSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9650
Mailing Address - Country:US
Mailing Address - Phone:443-616-3816
Mailing Address - Fax:
Practice Address - Street 1:4900 HORSEHILL RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MD
Practice Address - Zip Code:21013-9650
Practice Address - Country:US
Practice Address - Phone:443-616-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist