Provider Demographics
NPI:1831585116
Name:VILLARREAL, REBEKAH JOY (MD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JOY
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:JOY
Other - Last Name:SIEFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1648
Mailing Address - Country:US
Mailing Address - Phone:207-288-8604
Mailing Address - Fax:207-801-5803
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1648
Practice Address - Country:US
Practice Address - Phone:207-288-8604
Practice Address - Fax:207-288-8602
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4630792084P0800X
MEMD231672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1790764512Medicaid