Provider Demographics
NPI:1407987340
Name:BLUNT, REBECCA LYNN (MS, NCC, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:BLUNT
Suffix:
Gender:F
Credentials:MS, NCC, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 OLIN RD
Mailing Address - Street 2:
Mailing Address - City:LOWMAN
Mailing Address - State:NY
Mailing Address - Zip Code:14861-8946
Mailing Address - Country:US
Mailing Address - Phone:607-732-1622
Mailing Address - Fax:607-732-1622
Practice Address - Street 1:280 PRINCETON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-1524
Practice Address - Country:US
Practice Address - Phone:607-962-3148
Practice Address - Fax:607-962-8422
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002147-1101YM0800X
PAPC002610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional