Provider Demographics
NPI:1326886193
Name:GARRITILLO, REBECCA (PMHNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GARRITILLO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-9219
Mailing Address - Country:US
Mailing Address - Phone:570-561-2982
Mailing Address - Fax:570-300-1829
Practice Address - Street 1:374 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-9219
Practice Address - Country:US
Practice Address - Phone:570-561-2982
Practice Address - Fax:570-300-1829
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN684620363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health