Provider Demographics
NPI:1639640659
Name:PRESTON, REBECCA MAE (LMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MAE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATUS
Mailing Address - State:NY
Mailing Address - Zip Code:13040-2195
Mailing Address - Country:US
Mailing Address - Phone:607-745-0989
Mailing Address - Fax:
Practice Address - Street 1:4045 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATUS
Practice Address - State:NY
Practice Address - Zip Code:13040-2195
Practice Address - Country:US
Practice Address - Phone:607-745-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health