Provider Demographics
NPI:1396236212
Name:CALLAWAY, REBECCA
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:CALLAWAY
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 1:7205 KATHLEEN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1442
Mailing Address - Country:US
Mailing Address - Phone:505-681-6012
Mailing Address - Fax:
Practice Address - Street 1:7205 KATHLEEN AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1442
Practice Address - Country:US
Practice Address - Phone:505-681-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician