Provider Demographics
NPI:1518732981
Name:DECARLO, REBECCA (NCC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DECARLO
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BOONE DECARLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCC
Mailing Address - Street 1:491 ALLENDALE RD STE 322
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1432
Mailing Address - Country:US
Mailing Address - Phone:610-906-9475
Mailing Address - Fax:
Practice Address - Street 1:491 ALLENDALE RD STE 322
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1432
Practice Address - Country:US
Practice Address - Phone:610-544-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health