Provider Demographics
NPI:1316105976
Name:CRECRAFT, REBECCA A (PSYD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:CRECRAFT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:7901 4TH ST N STE 24829
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:727-265-2132
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N STE 24829
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:727-265-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical