Provider Demographics
NPI:1558880559
Name:BURKE, REBEKAH SMITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:SMITH
Last Name:BURKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:249 GLENWOOD RD BLDG 4E
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1603
Mailing Address - Country:US
Mailing Address - Phone:607-217-6584
Mailing Address - Fax:607-741-4876
Practice Address - Street 1:229-231 STATE ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-2777
Practice Address - Country:US
Practice Address - Phone:607-771-7784
Practice Address - Fax:607-771-6528
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical