MEDICARE: JESSICA ANN REBELO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	96235	NY

General Provider Information

NPI Number	:	1093324600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN REBELO LCSW

Provider Business Mailing Address
First Line	:	169 COMMACK RD # 1015
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-3442
Country	:	US
Telephone Number	:	631-432-8897
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 COMMACK RD # 1015
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-3442
Country	:	US
Telephone Number	:	631-432-8897
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	01/04/2023

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Directions to “ JESSICA ANN REBELO LCSW” Practice Location

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