Provider Demographics
NPI:1558511600
Name:FREDERICK, REBECCA ANNE
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANNE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2639 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1727
Mailing Address - Country:US
Mailing Address - Phone:401-214-8558
Mailing Address - Fax:401-214-3047
Practice Address - Street 1:2639 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1727
Practice Address - Country:US
Practice Address - Phone:401-214-8558
Practice Address - Fax:401-214-3047
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01388103TP2701X, 103TP2701X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program