Healthcare Provider Details

I. General information

NPI: 1396728184
Provider Name (Legal Business Name): REBECCA KIRKWOOD PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA BERNAS. PSY.D

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 CLEVELAND AVE SUITE 814
FT MYERS FL
33901
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-334-5634
  • Fax:
Mailing address:
  • Phone: 239-343-3900
  • Fax: 239-343-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: