Healthcare Provider Details

I. General information

NPI: 1871530600
Provider Name (Legal Business Name): REBECCA KARDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN STREET, GROUND FLOOR UMASS MEMORIAL MED CTR, AMBULATORY PSYCHIATRY SERVICE
WORCESTER MA
01610
US

IV. Provider business mailing address

26 QUEEN STREET, GROUND FLOOR UMASS MEMORIAL MED CTR, AMBULATORY PSYCHIATRY SERVICE
WORCESTER MA
01610
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-2537
  • Fax: 508-334-4320
Mailing address:
  • Phone: 508-334-2537
  • Fax: 508-334-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number84306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: