Provider Demographics
NPI:1619113727
Name:BUCCHERI, REBEKAH ANNE (PHD, SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:ANNE
Last Name:BUCCHERI
Suffix:
Gender:F
Credentials:PHD, SLP-CCC
Other - Prefix:DR
Other - First Name:REBEKAH
Other - Middle Name:ANNE
Other - Last Name:KALLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, SLP-CCC
Mailing Address - Street 1:6092 60TH RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3539
Mailing Address - Country:US
Mailing Address - Phone:718-381-3812
Mailing Address - Fax:
Practice Address - Street 1:6092 60TH RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3539
Practice Address - Country:US
Practice Address - Phone:718-381-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00531300235Z00000X
NY016854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist