Provider Demographics
NPI:1184754418
Name:FLEETWOOD, REBECCA (MA, MT-BC,LCAT)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:MA, MT-BC,LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SAINT PAULS AVE
Mailing Address - Street 2:APT 14S
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3724
Mailing Address - Country:US
Mailing Address - Phone:646-522-1042
Mailing Address - Fax:
Practice Address - Street 1:207 E 84TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2972
Practice Address - Country:US
Practice Address - Phone:646-522-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000510225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist