| Entity Name: | REBECCA ANDERSON PHD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Dec 2020 (4 years ago) |
| Document Number: | L20000393445 |
| FEI/EIN Number | 86-1224906 |
| Address: | 9210 ESTERO PARK COMMONS, SUITE 7, Estero, FL, 33928, US |
| Mail Address: | 2197 PINE WOODS CIRCLE, NAPLES, FL, 34105, US |
| ZIP code: | 33928 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043800493 | 2021-01-20 | 2024-04-27 | 2197 PINE WOODS CIR, NAPLES, FL, 341052543, US | 9210 ESTERO PARK COMMONS BLVD STE 7, ESTERO, FL, 339286395, US | |||||||||||||||||||||
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| Phone | +1 413-246-5499 |
| Phone | +1 239-351-5979 |
| Fax | 2594957772 |
Authorized person
| Name | REBECCA G ANDERSON |
| Role | PSYCHOLOGIST |
| Phone | 2393515979 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI - TYPE 1 |
| Number | 1538104302 |
| Name | Role | Address |
|---|---|---|
| G ANDERSON REBECCA | Agent | 2197 PINEWOODS CIRCLE, NAPLES, FL, 34105 |
| Name | Role | Address |
|---|---|---|
| ANDERSON REBECCA G | Manager | 2197 PINEWOODS CIRCLE, NAPLES, FL, 34105 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-31 | 9210 ESTERO PARK COMMONS, SUITE 7, Estero, FL 33928 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-31 | 9210 ESTERO PARK COMMONS, SUITE 7, Estero, FL 33928 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-31 | G ANDERSON, REBECCA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-31 | 2197 PINEWOODS CIRCLE, NAPLES, FL 34105 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-13 |
| ANNUAL REPORT | 2022-01-28 |
| Florida Limited Liability | 2020-12-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
