Provider Demographics
NPI:1932924156
Name:BONGIOVI, REBECCA ELINOR
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELINOR
Last Name:BONGIOVI
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 1:313 KLEE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-1348
Mailing Address - Country:US
Mailing Address - Phone:540-422-1667
Mailing Address - Fax:
Practice Address - Street 1:21351 GENTRY DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8501
Practice Address - Country:US
Practice Address - Phone:703-493-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health