Healthcare Provider Details

I. General information

NPI: 1679086201
Provider Name (Legal Business Name): REBECCA AVIS GEBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 BEECH ST
HOLYOKE MA
01040-3968
US

IV. Provider business mailing address

319 BEECH STREET
HOLYOKE MA
01040
US

V. Phone/Fax

Practice location:
  • Phone: 413-540-1160
  • Fax: 413-533-1016
Mailing address:
  • Phone: 413-540-1160
  • Fax: 413-533-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: