Healthcare Provider Details

I. General information

NPI: 1558650077
Provider Name (Legal Business Name): REBECCA JANE BIBEAU M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA JANE FISH

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CRANK RD
HAMPTON FALLS NH
03844-2102
US

IV. Provider business mailing address

9 CRANK RD
HAMPTON FALLS NH
03844-2102
US

V. Phone/Fax

Practice location:
  • Phone: 978-884-0635
  • Fax:
Mailing address:
  • Phone: 978-884-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: