Provider Demographics
NPI:1023153889
Name:BEARDSLEY, REBECCA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARIE
Last Name:BEARDSLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O ABS PO BOX 60599
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-7599
Mailing Address - Country:US
Mailing Address - Phone:808-664-1104
Mailing Address - Fax:866-592-3149
Practice Address - Street 1:1833 KALAKAUA AVE STE 908
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1528
Practice Address - Country:US
Practice Address - Phone:808-664-1104
Practice Address - Fax:866-592-3149
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN