Provider Demographics
NPI:1356143754
Name:VICTOR, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:VICTOR
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 1:388 PLEASANT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-0001
Mailing Address - Country:US
Mailing Address - Phone:781-472-4049
Mailing Address - Fax:617-977-9761
Practice Address - Street 1:388 PLEASANT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-0001
Practice Address - Country:US
Practice Address - Phone:781-472-4049
Practice Address - Fax:617-977-9761
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASA9650505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health