Provider Demographics
NPI:1922212646
Name:EADES, REBECCA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:EADES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 OUTER RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:871 OUTER RD
Practice Address - Street 2:UNIT D
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6686
Practice Address - Country:US
Practice Address - Phone:407-488-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7267103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling