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NPI Code Detail

MEDICARE: DR. REBECCA LYNN PEARL PH.D.

MEDICARE: DR. REBECCA LYNN PEARL PH.D.
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
1103T00000XPsychologistPS018139PA
2103TC0700XClinical PsychologistPY11138FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538421474
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA LYNN PEARL PH.D.
Provider Business Mailing Address
First Line : PO BOX 100165
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-0165
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3535 MARKET ST
Second Line : SUITE 3026
City : PHILADELPHIA
State : PA
Zip : 19104-3309
Country : US
Telephone Number : 215-746-5129
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2012
Last Update Date : 09/17/2021

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