Healthcare Provider Details

I. General information

NPI: 1043223001
Provider Name (Legal Business Name): REBECCA B CHANDLER LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS REBECCA B BOUDREAU

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 YORK RD SUITE 309
LUTHERVILLE TIMONIUM MD
21093-6097
US

IV. Provider business mailing address

1731 GABLEHAMMER RD
WESTMINSTER MD
21157-3953
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-2281
  • Fax: 410-825-0757
Mailing address:
  • Phone: 410-825-2281
  • Fax: 410-825-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number06615
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06615
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: