MEDICARE: REBECCA EDDY MUCCILLI PSY.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	9462	MA

General Provider Information

NPI Number	:	1518390905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBECCA EDDY MUCCILLI PSY.D., LLC

Provider Business Mailing Address
First Line	:	75 ARLINGTON ST
Second Line	:	SUITE 500
City	:	BOSTON
State	:	MA
Zip	:	02116-3936
Country	:	US
Telephone Number	:	617-750-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 ARLINGTON ST
Second Line	:	SUITE 500
City	:	BOSTON
State	:	MA
Zip	:	02116-3936
Country	:	US
Telephone Number	:	617-750-8222
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. REBECCA EDDY MUCCILLI
Credential	:	PSY.D.
Telephone Number	:	617-750-8222

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

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