MEDICARE: REBECCA ALICE ENCINAS 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	1041C0700X	Clinical Social Worker	LCSW19958	AZ

General Provider Information

NPI Number	:	1265199327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ALICE ENCINAS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 700
Second Line	:
City	:	NEW KNOXVILLE
State	:	OH
Zip	:	45871-0700
Country	:	US
Telephone Number	:	480-392-6418
Fax Number	:

Provider Business Practice Location Address
First Line	:	19100 E SHELBY RD
Second Line	:
City	:	NEW KNOXVILLE
State	:	OH
Zip	:	45871-9531
Country	:	US
Telephone Number	:	480-392-6418
Fax Number	:

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

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	11/23/2021

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