Provider Demographics
NPI:1265759336
Name:MOONEYHAN, REBECCA LYNN (MHDL, CAS)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:MOONEYHAN
Suffix:
Gender:F
Credentials:MHDL, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4151
Mailing Address - Country:US
Mailing Address - Phone:407-893-7237
Mailing Address - Fax:407-893-7221
Practice Address - Street 1:2000 S MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4151
Practice Address - Country:US
Practice Address - Phone:407-893-7237
Practice Address - Fax:407-893-7221
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL139101Y00000X
NC0974101YP2500X
NC7055101YP2500X
FL101YS0200X
NC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional