MEDICARE: REBEKAH BOOTH

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	175T00000X	Peer Specialist		NJ

General Provider Information

NPI Number	:	1710702311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH BOOTH

Provider Business Mailing Address
First Line	:	333 GLEN ST STE 701
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-3542
Country	:	US
Telephone Number	:	518-798-4384
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 GLEN ST STE 701
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-3542
Country	:	US
Telephone Number	:	518-798-4384
Fax Number	:

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

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/19/2024

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Directions to “ REBEKAH BOOTH ” Practice Location

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