Provider Demographics
NPI:1265283212
Name:DATTLO, REBECCA SHOSHANA (MS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SHOSHANA
Last Name:DATTLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:RIVKA
Other - Middle Name:
Other - Last Name:DATTLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:583 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2905
Mailing Address - Country:US
Mailing Address - Phone:215-962-7771
Mailing Address - Fax:
Practice Address - Street 1:583 BYRON RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2905
Practice Address - Country:US
Practice Address - Phone:215-962-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health