Provider Demographics
NPI:1588857825
Name:ANASTASI, REBECCA JO (MA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:ANASTASI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10513 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2065
Mailing Address - Country:US
Mailing Address - Phone:248-245-4633
Mailing Address - Fax:
Practice Address - Street 1:10513 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-2065
Practice Address - Country:US
Practice Address - Phone:248-245-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional