Provider Demographics
NPI:1104126945
Name:SHULMAN, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST WALLINGFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05742-9614
Mailing Address - Country:US
Mailing Address - Phone:802-345-1312
Mailing Address - Fax:
Practice Address - Street 1:40 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3405
Practice Address - Country:US
Practice Address - Phone:802-345-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001217531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical