Provider Demographics
NPI:1861515082
Name:MIGENES, REBECCA JULIA (MSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JULIA
Last Name:MIGENES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BOVINGTON LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9751
Mailing Address - Country:US
Mailing Address - Phone:315-427-0305
Mailing Address - Fax:
Practice Address - Street 1:19 BOVINGTON LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-9751
Practice Address - Country:US
Practice Address - Phone:315-427-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037756171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor