Provider Demographics
NPI:1770878936
Name:MARGERUM MACLEOD, REBECCA LYNN (MS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:MARGERUM MACLEOD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:MARGERUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:157 E NEW ENGLAND AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4346
Mailing Address - Country:US
Mailing Address - Phone:407-644-4231
Mailing Address - Fax:407-628-8996
Practice Address - Street 1:157 E NEW ENGLAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4346
Practice Address - Country:US
Practice Address - Phone:407-644-4231
Practice Address - Fax:407-628-8996
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health