Provider Demographics
NPI:1396728184
Name:KIRKWOOD, REBECCA (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KIRKWOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BERNAS.
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-3900
Mailing Address - Fax:239-343-3144
Practice Address - Street 1:2776 CLEVELAND AVE
Practice Address - Street 2:SUITE 814
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-334-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5865103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023170700Medicaid
FLE3181ZMedicare UPIN
FLE3181YMedicare PIN