Provider Demographics
NPI:1871921106
Name:VAN DYKE, REBECCA ELIZABETH (MA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:VAN DYKE
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 1:111 MIDDLETON RD
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4000
Mailing Address - Country:US
Mailing Address - Phone:978-777-2121
Mailing Address - Fax:978-774-4814
Practice Address - Street 1:111 MIDDLETON RD
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-4000
Practice Address - Country:US
Practice Address - Phone:978-777-2121
Practice Address - Fax:978-774-4814
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health