Provider Demographics
NPI:1285296129
Name:CROFT, REBEKKA
Entity type:Individual
Prefix:
First Name:REBEKKA
Middle Name:
Last Name:CROFT
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 1:319 STEWARTS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:PENNELLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13132-3238
Mailing Address - Country:US
Mailing Address - Phone:607-643-1763
Mailing Address - Fax:
Practice Address - Street 1:3532 JAMES ST STE 112
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2722
Practice Address - Country:US
Practice Address - Phone:315-963-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker