Healthcare Provider Details

I. General information

NPI: 1174073647
Provider Name (Legal Business Name): REBECCA GILDEA LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2016
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 JENKINS CT STE 241
DURHAM NH
03824-2324
US

IV. Provider business mailing address

13 JENKINS CT STE 241
DURHAM NH
03824-2324
US

V. Phone/Fax

Practice location:
  • Phone: 207-977-4861
  • Fax:
Mailing address:
  • Phone: 207-977-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4957
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12668
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: