Provider Demographics
NPI:1053039966
Name:STINE, REBECCA LEIGH (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEIGH
Last Name:STINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LEIGH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:20134 VALLEY FORGE CIR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1112
Mailing Address - Country:US
Mailing Address - Phone:610-878-9330
Mailing Address - Fax:267-552-1002
Practice Address - Street 1:20134 VALLEY FORGE CIR
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1112
Practice Address - Country:US
Practice Address - Phone:610-878-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical