Provider Demographics
NPI:1679623037
Name:FOGARTY, REBECCA (MS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1880 SHASTA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0417
Mailing Address - Country:US
Mailing Address - Phone:530-248-3000
Mailing Address - Fax:
Practice Address - Street 1:1880 SHASTA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0417
Practice Address - Country:US
Practice Address - Phone:530-248-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 50098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist