Provider Demographics
NPI:1831486778
Name:RISER, REBECCA (NASTASSIA) E (MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA (NASTASSIA)
Middle Name:E
Last Name:RISER
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:DR
Other - First Name:NASTASSIA
Other - Middle Name:REBECCA
Other - Last Name:RISER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PHD
Mailing Address - Street 1:700 GARDEN VIEW CT STE 201J
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2479
Mailing Address - Country:US
Mailing Address - Phone:760-492-9057
Mailing Address - Fax:
Practice Address - Street 1:700 GARDEN VIEW CT STE 201J
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2479
Practice Address - Country:US
Practice Address - Phone:760-492-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA30973103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health