Provider Demographics
NPI:1659506640
Name:MONTGOMERY, REBEKAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:MAJORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:10 POST OFFICE SQ
Mailing Address - Street 2:SUITE 800 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4603
Mailing Address - Country:US
Mailing Address - Phone:617-692-2938
Mailing Address - Fax:617-692-2901
Practice Address - Street 1:10 POST OFFICE SQ
Practice Address - Street 2:SUITE 800 SOUTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4603
Practice Address - Country:US
Practice Address - Phone:617-692-2938
Practice Address - Fax:617-692-2901
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
RIPS01192103TC0700X
MA9647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist