Provider Demographics
NPI:1154992709
Name:FEDE, REBECCA HILDA (LMFTA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HILDA
Last Name:FEDE
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4216
Mailing Address - Country:US
Mailing Address - Phone:860-628-1469
Mailing Address - Fax:
Practice Address - Street 1:900 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4216
Practice Address - Country:US
Practice Address - Phone:860-628-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27.002622-ASOC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health