Provider Demographics
NPI:1114264827
Name:MIGNONE, REBECCA (MS, ED)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MIGNONE
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUMMIT BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11977-1126
Mailing Address - Country:US
Mailing Address - Phone:516-578-2642
Mailing Address - Fax:
Practice Address - Street 1:9 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1126
Practice Address - Country:US
Practice Address - Phone:516-578-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist