Provider Demographics
NPI:1326528373
Name:EDELSBERG, REBECCA T (PSY-D)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:T
Last Name:EDELSBERG
Suffix:
Gender:F
Credentials:PSY-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 STILLWELLS CORNER
Mailing Address - Street 2:BUILDING E, SUITE 7
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-683-2322
Mailing Address - Fax:
Practice Address - Street 1:509 STILLWELLS CORNER
Practice Address - Street 2:BUILDING E, SUITE 7
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-683-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ183-051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical