Provider Demographics
NPI:1013295898
Name:BRODERSEN, REBECCA FALCETTA
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:FALCETTA
Last Name:BRODERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-0918
Mailing Address - Country:US
Mailing Address - Phone:860-399-9239
Mailing Address - Fax:860-399-7529
Practice Address - Street 1:1163 BOSTON POST RD
Practice Address - Street 2:WESTBROOK YOUTH AND FAMILY SERVICES
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1947
Practice Address - Country:US
Practice Address - Phone:860-399-9239
Practice Address - Fax:860-399-7529
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist