Healthcare Provider Details

I. General information

NPI: 1255580114
Provider Name (Legal Business Name): REBEKAH KUKOWSKI LCSWR-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 10/08/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LEROY ST
BINGHAMTON NY
13905-4603
US

IV. Provider business mailing address

14 LEROY ST
BINGHAMTON NY
13905-4603
US

V. Phone/Fax

Practice location:
  • Phone: 607-341-2034
  • Fax: 607-724-3865
Mailing address:
  • Phone: 607-341-2034
  • Fax: 607-724-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079628
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: