Provider Demographics
NPI:1093347288
Name:LEADER, REBECCA MARY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARY
Last Name:LEADER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 ALTA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-8404
Mailing Address - Country:US
Mailing Address - Phone:518-339-5396
Mailing Address - Fax:
Practice Address - Street 1:1750 ALTA VISTA ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8404
Practice Address - Country:US
Practice Address - Phone:518-339-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health