Healthcare Provider Details

I. General information

NPI: 1669022794
Provider Name (Legal Business Name): REBECCA LYNN ARCIDIACONO LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 OLMSTEAD RD
REDDING CT
06896-1021
US

IV. Provider business mailing address

43 OLMSTEAD RD
REDDING CT
06896-1021
US

V. Phone/Fax

Practice location:
  • Phone: 914-719-6643
  • Fax:
Mailing address:
  • Phone: 914-719-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11935
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: