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NPI Code Detail

MEDICARE: REBEKAH NIELSON LCADC

MEDICARE: REBEKAH NIELSON LCADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor37LC00240300NJ

General Provider Information

NPI Number : 1245884204
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBEKAH NIELSON LCADC
Provider Business Mailing Address
First Line : 2701 RENAISSANCE BLVD FL 4
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-2781
Country : US
Telephone Number : 484-803-9663
Fax Number : 484-393-4096
Provider Business Practice Location Address
First Line : 801 NEW YORK AVE
Second Line :
City : TRENTON
State : NJ
Zip : 08638-3913
Country : US
Telephone Number : 609-393-8000
Fax Number : 609-393-8020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2019
Last Update Date : 07/29/2019

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