Provider Demographics
NPI:1063549772
Name:CLARK, REBECCA ERDE (LMFT-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ERDE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMFT-C
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ERDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:ME
Mailing Address - Zip Code:04553-0297
Mailing Address - Country:US
Mailing Address - Phone:207-563-3366
Mailing Address - Fax:207-563-3393
Practice Address - Street 1:80 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:ME
Practice Address - Zip Code:04553-3838
Practice Address - Country:US
Practice Address - Phone:207-563-3366
Practice Address - Fax:207-563-3393
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXM2762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist