Provider Demographics
NPI:1821799198
Name:MAE, REBECCA (MA MFT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:MAE
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:CHUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4819 207TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1112
Mailing Address - Country:US
Mailing Address - Phone:718-640-7029
Mailing Address - Fax:
Practice Address - Street 1:243 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY S
Practice Address - State:NY
Practice Address - Zip Code:11530-5532
Practice Address - Country:US
Practice Address - Phone:516-387-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP103766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional