Provider Demographics
NPI:1669923975
Name:UTH, REBECCA (PSYD)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:UTH
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:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-0610
Mailing Address - Country:US
Mailing Address - Phone:508-386-2094
Mailing Address - Fax:508-967-7194
Practice Address - Street 1:171 HIGHLAND STREET
Practice Address - Street 2:UNIT 303
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-4446
Practice Address - Country:US
Practice Address - Phone:508-386-2094
Practice Address - Fax:508-967-7194
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10471103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical