Provider Demographics
NPI:1649630799
Name:KANEFSKY, REBEKAH (LPC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:KANEFSKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 HIGH RIDGE RD STE 245
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1203
Mailing Address - Country:US
Mailing Address - Phone:203-614-9114
Mailing Address - Fax:
Practice Address - Street 1:66 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3328
Practice Address - Country:US
Practice Address - Phone:646-334-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008067525Medicaid