Provider Demographics
NPI:1942359963
Name:EVANS, REBECCA B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:B
Last Name:EVANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:B
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 16082
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-0698
Mailing Address - Country:US
Mailing Address - Phone:401-339-6449
Mailing Address - Fax:
Practice Address - Street 1:10 STONE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-2921
Practice Address - Country:US
Practice Address - Phone:401-437-7444
Practice Address - Fax:401-414-0671
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10072103TC0700X
RIPS01399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical