MEDICARE: REBECCA JOY VAN DELLEN MSW

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

General Provider Information

NPI Number	:	1538226634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JOY VAN DELLEN MSW

Provider Business Mailing Address
First Line	:	3445 SHAUNA OAKS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2952
Country	:	US
Telephone Number	:	904-783-2579
Fax Number	:

Provider Business Practice Location Address
First Line	:	6316 SAN JUAN AVE
Second Line	:	SUITE 41
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2831
Country	:	US
Telephone Number	:	904-783-2979
Fax Number	:

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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