Provider Demographics
NPI:1205226990
Name:CHASE, REBECCA (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W 76TH ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1526
Mailing Address - Country:US
Mailing Address - Phone:646-369-2068
Mailing Address - Fax:
Practice Address - Street 1:8 W 76TH ST
Practice Address - Street 2:APT 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1526
Practice Address - Country:US
Practice Address - Phone:646-369-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical