Provider Demographics
NPI:1952459539
Name:SCHWARTZ, REBECCA LISA (MA, MF T)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LISA
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MA, MF T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAPLE CT
Mailing Address - Street 2:SUITE#115
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3516
Mailing Address - Country:US
Mailing Address - Phone:805-658-9202
Mailing Address - Fax:805-658-0258
Practice Address - Street 1:260 MAPLE CT
Practice Address - Street 2:SUITE#115
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3516
Practice Address - Country:US
Practice Address - Phone:805-658-9202
Practice Address - Fax:805-658-0258
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC21840OtherMFT LICENSE NUMBER