Provider Demographics
NPI:1710323035
Name:DUA, REBEKAH
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:DUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ELIZABETH
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1R NEWBURY ST STE 211
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3816
Mailing Address - Country:US
Mailing Address - Phone:978-778-4924
Mailing Address - Fax:978-871-2098
Practice Address - Street 1:1R NEWBURY ST STE 211
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3816
Practice Address - Country:US
Practice Address - Phone:978-778-4924
Practice Address - Fax:978-871-2098
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1203671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical