Healthcare Provider Details

I. General information

NPI: 1831021872
Provider Name (Legal Business Name): REBECCA ANN WILLIS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

76 SAWYER HILL RD
BERLIN MA
01503-1704
US

V. Phone/Fax

Practice location:
  • Phone: 855-862-7763
  • Fax:
Mailing address:
  • Phone: 508-768-5965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW229611
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: