Provider Demographics
NPI:1255432423
Name:ELLINGER, REBECCA S (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:ELLINGER
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 1:16244 S MILITARY TRAIL
Mailing Address - Street 2:SUITE 460
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:561-498-5300
Mailing Address - Fax:561-498-5301
Practice Address - Street 1:16244 S MILITARY TRAIL
Practice Address - Street 2:SUITE 460
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-498-5300
Practice Address - Fax:561-498-5301
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 4112103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73419Medicare ID - Type Unspecified