Healthcare Provider Details

I. General information

NPI: 1720700099
Provider Name (Legal Business Name): REBEKAH J CHITTENDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W MAIN ST
MT STERLING KY
40353-1348
US

IV. Provider business mailing address

236 W MAIN ST
MT STERLING KY
40353-1348
US

V. Phone/Fax

Practice location:
  • Phone: 859-309-7710
  • Fax: 859-274-4459
Mailing address:
  • Phone: 859-309-7710
  • Fax: 859-274-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001745
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2309673
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: