Healthcare Provider Details

I. General information

NPI: 1922212646
Provider Name (Legal Business Name): REBECCA A. EADES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 OUTER RD UNIT D
ORLANDO FL
32814-6686
US

IV. Provider business mailing address

871 OUTER RD UNIT D
ORLANDO FL
32814-6686
US

V. Phone/Fax

Practice location:
  • Phone: 407-488-0850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 7267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: