Provider Demographics
NPI:1285033688
Name:REBECCA DENNIS
Entity Type:Organization
Organization Name:REBECCA DENNIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CREATIVE ARTS THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT
Authorized Official - Phone:607-379-3370
Mailing Address - Street 1:402 N TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5229
Mailing Address - Country:US
Mailing Address - Phone:508-864-6927
Mailing Address - Fax:
Practice Address - Street 1:108 S ALBANY ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5446
Practice Address - Country:US
Practice Address - Phone:607-379-3370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001801-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty