MEDICARE: REBECCA MOON

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	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor

Other Identifiers

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

General Provider Information

NPI Number	:	1588307417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MOON

Provider Business Mailing Address
First Line	:	2541 E 19TH ST STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3519
Country	:	US
Telephone Number	:	347-708-0777
Fax Number	:

Provider Business Practice Location Address
First Line	:	2541 E 19TH ST STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3519
Country	:	US
Telephone Number	:	347-708-0777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	09/04/2024

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Directions to “ REBECCA MOON ” Practice Location

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