Provider Demographics
NPI:1063512671
Name:KATOVSICH, REBECCA BENNETT (PHD, LLP, LMSW)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:BENNETT
Last Name:KATOVSICH
Suffix:
Gender:F
Credentials:PHD, LLP, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1426
Mailing Address - Country:US
Mailing Address - Phone:269-985-2000
Mailing Address - Fax:269-985-2002
Practice Address - Street 1:903 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1426
Practice Address - Country:US
Practice Address - Phone:269-985-2000
Practice Address - Fax:269-985-2002
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801080778104100000X, 1041C0700X
MI6301013818103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRK080778OtherBLUE CROSS BLUE SHIELD
MI8008979580OtherBCBS