Provider Demographics
NPI:1154857720
Name:DAVIS, REBECCA I (MA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:I
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 WARDON RD
Mailing Address - Street 2:
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346-8980
Mailing Address - Country:US
Mailing Address - Phone:802-387-2757
Mailing Address - Fax:
Practice Address - Street 1:54 HARRIS PL
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7127
Practice Address - Country:US
Practice Address - Phone:802-258-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0129615101Y00000X
VT068.0134940101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor