MEDICARE: REBEL BEHAVIORAL HEALTH PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1821954280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBEL BEHAVIORAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	82 BAY DR
Second Line	:
City	:	CANTON
State	:	MA
Zip	:	02021-4182
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 OLD DERBY ST STE 211
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4066
Country	:	US
Telephone Number	:	518-414-1214
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	SARAH MARIE REBEL
Credential	:	PMHNP
Telephone Number	:	518-414-1214

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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