Provider Demographics
NPI:1942790639
Name:PREISER, REBECCA (PSYD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PREISER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LEOPARD RD STE 304
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1549
Mailing Address - Country:US
Mailing Address - Phone:610-642-4873
Mailing Address - Fax:
Practice Address - Street 1:41 LEOPARD RD STE 304
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1549
Practice Address - Country:US
Practice Address - Phone:610-642-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-018245103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist