Provider Demographics
NPI:1376992065
Name:YANDLE, REBECCA JEAN (MA, CASAC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JEAN
Last Name:YANDLE
Suffix:
Gender:F
Credentials:MA, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3312
Mailing Address - Country:US
Mailing Address - Phone:845-486-8880
Mailing Address - Fax:845-486-8885
Practice Address - Street 1:412 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3312
Practice Address - Country:US
Practice Address - Phone:845-486-8880
Practice Address - Fax:845-486-8885
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30159101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)