Provider Demographics
NPI:1144569807
Name:DISUNNO, REBECCA E (PHD,RNCS,LCAT)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:DISUNNO
Suffix:
Gender:F
Credentials:PHD,RNCS,LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BUELL LN
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-3212
Mailing Address - Country:US
Mailing Address - Phone:631-329-1486
Mailing Address - Fax:
Practice Address - Street 1:44 BUELL LN
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-3212
Practice Address - Country:US
Practice Address - Phone:631-329-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219377-1101YM0800X
NY000096-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health