Provider Demographics
NPI:1396007530
Name:ROPER-ECKSTEIN, REBECCA GOWANS (MS ED)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GOWANS
Last Name:ROPER-ECKSTEIN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 JEFFERSON ST
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2031
Mailing Address - Country:US
Mailing Address - Phone:845-642-1186
Mailing Address - Fax:
Practice Address - Street 1:24 OLD GLENHAM ROAD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-642-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1359085103TS0200X
NY2359073174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No174400000XOther Service ProvidersSpecialist