Provider Demographics
NPI:1518390905
Name:REBECCA EDDY MUCCILLI PSY.D., LLC
Entity type:Organization
Organization Name:REBECCA EDDY MUCCILLI PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDY MUCCILLI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-750-8222
Mailing Address - Street 1:75 ARLINGTON ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3936
Mailing Address - Country:US
Mailing Address - Phone:617-750-8222
Mailing Address - Fax:
Practice Address - Street 1:75 ARLINGTON ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3936
Practice Address - Country:US
Practice Address - Phone:617-750-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty