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NPI Code Detail

MEDICARE: REBECCA JO FIDLER LMHC

MEDICARE: REBECCA JO FIDLER LMHC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1801917638
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA JO FIDLER LMHC
Provider Business Mailing Address
First Line : 189 TWIN LAKES DR
Second Line :
City : HALIFAX
State : MA
Zip : 02338-2213
Country : US
Telephone Number : 508-641-6492
Fax Number :
Provider Business Practice Location Address
First Line : 1120 HANCOCK ST
Second Line :
City : QUINCY
State : MA
Zip : 02169-4313
Country : US
Telephone Number : 617-471-8400
Fax Number : 617-376-8410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 09/02/2014

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