Provider Demographics
NPI:1366286007
Name:DRAPER, REBECCA SUE (PSYD, LMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:DRAPER
Suffix:
Gender:F
Credentials:PSYD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1225
Mailing Address - Country:US
Mailing Address - Phone:585-781-0979
Mailing Address - Fax:
Practice Address - Street 1:3380 MONROE AVE STE 218
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4726
Practice Address - Country:US
Practice Address - Phone:585-781-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024882103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical