Provider Demographics
NPI:1518012996
Name:WARBURTON, REBECCA MUNN (LIC CLN PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MUNN
Last Name:WARBURTON
Suffix:
Gender:F
Credentials:LIC CLN PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-396-1806
Mailing Address - Fax:781-396-5086
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-396-1806
Practice Address - Fax:781-396-5086
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA9007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2399169OtherCIGNA
MA2399169OtherCIGNA