Provider Demographics
NPI:1841746237
Name:PICARD, REBECCA M (MA)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:M
Last Name:PICARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JD, LLM, MA
Mailing Address - Street 1:PO BOX 832
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-0832
Mailing Address - Country:US
Mailing Address - Phone:707-357-8688
Mailing Address - Fax:707-962-9237
Practice Address - Street 1:45121 UKIAH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460
Practice Address - Country:US
Practice Address - Phone:707-357-8688
Practice Address - Fax:707-962-9237
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF93080106H00000X
CA112212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist