Healthcare Provider Details

I. General information

NPI: 1174115349
Provider Name (Legal Business Name): REBECCA TRAUB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RAYMOND RD
FALMOUTH ME
04105-1414
US

IV. Provider business mailing address

8 RAYMOND RD
FALMOUTH ME
04105-1414
US

V. Phone/Fax

Practice location:
  • Phone: 207-266-8941
  • Fax:
Mailing address:
  • Phone: 207-266-8941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11210
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC5634
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: