Provider Demographics
NPI:1710117981
Name:MCKNIGHT, REBECCA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2626 COLIBRI LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4303
Mailing Address - Country:US
Mailing Address - Phone:619-997-7520
Mailing Address - Fax:
Practice Address - Street 1:621 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3568
Practice Address - Country:US
Practice Address - Phone:619-997-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical