Healthcare Provider Details

I. General information

NPI: 1801917638
Provider Name (Legal Business Name): REBECCA JO FIDLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 HANCOCK ST
QUINCY MA
02169-4313
US

IV. Provider business mailing address

189 TWIN LAKES DR
HALIFAX MA
02338-2213
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-8400
  • Fax: 617-376-8410
Mailing address:
  • Phone: 508-641-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: