Provider Demographics
NPI:1558650077
Name:BIBEAU, REBECCA JANE (MED)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JANE
Last Name:BIBEAU
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JANE
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CRANK RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03844-2102
Mailing Address - Country:US
Mailing Address - Phone:978-884-0635
Mailing Address - Fax:
Practice Address - Street 1:9 CRANK RD
Practice Address - Street 2:
Practice Address - City:HAMPTON FALLS
Practice Address - State:NH
Practice Address - Zip Code:03844-2102
Practice Address - Country:US
Practice Address - Phone:978-884-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor