Provider Demographics
NPI:1164636734
Name:ACKERMAN, REBECA (PPSC)
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 OTAY MESA RD
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1617
Mailing Address - Country:US
Mailing Address - Phone:619-428-4476
Mailing Address - Fax:619-428-1393
Practice Address - Street 1:4350 OTAY MESA RD
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-1617
Practice Address - Country:US
Practice Address - Phone:619-428-4476
Practice Address - Fax:619-428-1393
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool