Provider Demographics
NPI:1023461050
Name:KATZ, REBECCA SUE (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:PROF
First Name:REBECCA
Middle Name:SUE
Last Name:KATZ
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:PROF
Other - First Name:BECKY
Other - Middle Name:SUE
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PEER SUPPORT SPECIAL
Mailing Address - Street 1:3479 BUCKHORN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1114
Mailing Address - Country:US
Mailing Address - Phone:859-246-7282
Mailing Address - Fax:
Practice Address - Street 1:3479 BUCKHORN DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1114
Practice Address - Country:US
Practice Address - Phone:859-246-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-04131041C0700X
KY278443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical