Provider Demographics
NPI:1053553818
Name:KIEFER, REBECCA P (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:P
Last Name:KIEFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 414
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4941
Mailing Address - Country:US
Mailing Address - Phone:804-592-2615
Mailing Address - Fax:804-592-5301
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 414
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4941
Practice Address - Country:US
Practice Address - Phone:804-592-2615
Practice Address - Fax:804-592-5301
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053553818Medicaid