Provider Demographics
NPI:1689644957
Name:ROONEY, REBECCA ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:ROONEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6523
Mailing Address - Country:US
Mailing Address - Phone:845-294-8442
Mailing Address - Fax:845-258-4611
Practice Address - Street 1:172 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6523
Practice Address - Country:US
Practice Address - Phone:845-294-8442
Practice Address - Fax:845-258-4611
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYV9I902103TC0700X
NY0118361103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V9I902Medicare ID - Type Unspecified