Provider Demographics
NPI:1235770108
Name:YU, REBECCA MARIE (MHC-LP, CASAC-T)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIE
Last Name:YU
Suffix:
Gender:F
Credentials:MHC-LP, CASAC-T
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2976 NORTHERN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2829
Mailing Address - Country:US
Mailing Address - Phone:347-510-3619
Mailing Address - Fax:
Practice Address - Street 1:2976 NORTHERN BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2829
Practice Address - Country:US
Practice Address - Phone:347-510-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP100666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health