Healthcare Provider Details

I. General information

NPI: 1427842467
Provider Name (Legal Business Name): REBECCA BISHOP MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 WOODROW AVE
DORCHESTER MA
02124-3233
US

IV. Provider business mailing address

1234 HYDE PARK AVE
HYDE PARK MA
02136-2819
US

V. Phone/Fax

Practice location:
  • Phone: 617-331-3516
  • Fax:
Mailing address:
  • Phone: 888-763-7272
  • Fax: 877-243-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: