Healthcare Provider Details

I. General information

NPI: 1649571134
Provider Name (Legal Business Name): REBECCA WELLS HUBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA WELLS PINKHAM LCSW

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 WASHINGTON STREET EXT
WILMINGTON DE
19809-2156
US

IV. Provider business mailing address

1359 PARKERVILLE RD
KENNETT SQUARE PA
19348-2114
US

V. Phone/Fax

Practice location:
  • Phone: 302-765-1100
  • Fax: 302-765-1107
Mailing address:
  • Phone: 610-388-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000691
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: