Healthcare Provider Details

I. General information

NPI: 1821954280
Provider Name (Legal Business Name): REBEL BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 OLD DERBY ST STE 211
HINGHAM MA
02043-4066
US

IV. Provider business mailing address

82 BAY DR
CANTON MA
02021-4182
US

V. Phone/Fax

Practice location:
  • Phone: 518-414-1214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SARAH MARIE REBEL
Title or Position: PMHNP
Credential: PMHNP
Phone: 518-414-1214