Provider Demographics
NPI:1598413486
Name:VERDIYAN, REBECCA ANNE (LMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:VERDIYAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:TIPSWORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 FITCHBURG ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1893
Mailing Address - Country:US
Mailing Address - Phone:417-693-9508
Mailing Address - Fax:
Practice Address - Street 1:47 WASHINGTON ST APT 413
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-6083
Practice Address - Country:US
Practice Address - Phone:417-693-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12890-MH-CC101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional