Healthcare Provider Details

I. General information

NPI: 1427579200
Provider Name (Legal Business Name): REBECCA KUKLINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 NORTH ST
NEW BEDFORD MA
02740-2782
US

IV. Provider business mailing address

10 DOVEKIE WAY
WAREHAM MA
02571-1727
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-8082
  • Fax:
Mailing address:
  • Phone: 774-201-1016
  • Fax:

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: