Provider Demographics
NPI:1720463748
Name:DEMIERI, REBEKAH (LMSW, MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:
Last Name:DEMIERI
Suffix:
Gender:F
Credentials:LMSW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 QUEENS AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-3522
Mailing Address - Country:US
Mailing Address - Phone:860-917-3971
Mailing Address - Fax:
Practice Address - Street 1:88 QUEENS AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-3522
Practice Address - Country:US
Practice Address - Phone:860-917-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTMUS.000013225A00000X
CT009921104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist