Provider Demographics
NPI:1750792099
Name:JAMISON, REBECCA G (LMHC, PHD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:G
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LMHC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-4043
Mailing Address - Country:US
Mailing Address - Phone:561-702-3565
Mailing Address - Fax:561-637-2595
Practice Address - Street 1:19 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-4043
Practice Address - Country:US
Practice Address - Phone:561-702-3565
Practice Address - Fax:561-637-2595
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health