Provider Demographics
NPI:1952600397
Name:MCNALLY, REBECCA YOUNG (MED)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:YOUNG
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JO
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BARLOWS LANDING RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-1980
Mailing Address - Country:US
Mailing Address - Phone:508-563-5767
Mailing Address - Fax:508-563-5774
Practice Address - Street 1:4 BARLOWS LANDING RD
Practice Address - Street 2:SUITE 13
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-1980
Practice Address - Country:US
Practice Address - Phone:508-563-5767
Practice Address - Fax:508-563-5774
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265Medicaid