Provider Demographics
NPI:1437319225
Name:REBECCA B. LAPIDUS, PHD, PC
Entity Type:Organization
Organization Name:REBECCA B. LAPIDUS, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAPIDUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-601-5475
Mailing Address - Street 1:PO BOX 271464
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-1464
Mailing Address - Country:US
Mailing Address - Phone:817-601-5475
Mailing Address - Fax:
Practice Address - Street 1:305 MIRON DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7831
Practice Address - Country:US
Practice Address - Phone:817-601-5475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-15
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37445251S00000X
GAPSY002881251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGRTMedicare PIN
GAQ68679Medicare UPIN