Healthcare Provider Details

I. General information

NPI: 1144656265
Provider Name (Legal Business Name): REBECCA ANN HENRICKS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST ST NE FL 9
WASHINGTON DC
20002-7953
US

IV. Provider business mailing address

1200 1ST ST NE FL 9
WASHINGTON DC
20002-7953
US

V. Phone/Fax

Practice location:
  • Phone: 202-322-3305
  • Fax:
Mailing address:
  • Phone: 202-322-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLG50078287
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC50082034
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: