Provider Demographics
NPI:1114095767
Name:KUNKEL, REBECCA A (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1405
Mailing Address - Country:US
Mailing Address - Phone:845-987-8765
Mailing Address - Fax:
Practice Address - Street 1:2 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1402
Practice Address - Country:US
Practice Address - Phone:845-294-8806
Practice Address - Fax:845-294-8650
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072636-11041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool