Provider Demographics
NPI:1760531933
Name:NELSON, REBECCA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 OLD WEST WRENTHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1012
Mailing Address - Country:US
Mailing Address - Phone:401-439-0706
Mailing Address - Fax:
Practice Address - Street 1:1525 OLD LOUISQUISSET PIKE
Practice Address - Street 2:B104
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4503
Practice Address - Country:US
Practice Address - Phone:401-721-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI0096106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1023290OtherBEACON HEALTH STRATEGIES
RI411440OtherBLUE CHIP
RI27139-6OtherBLUE CROSS
RI6272791OtherUNITED HEALTH
RIFM49368Medicaid