Provider Demographics
NPI:1962779306
Name:LOIS, REBECCA (PHD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LOIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 SIXTH AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1201
Mailing Address - Country:US
Mailing Address - Phone:413-329-8222
Mailing Address - Fax:718-405-5953
Practice Address - Street 1:3340 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2802
Practice Address - Country:US
Practice Address - Phone:718-696-3041
Practice Address - Fax:718-405-5953
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019408103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical