Healthcare Provider Details

I. General information

NPI: 1790528131
Provider Name (Legal Business Name): REBECCA WALSMAN MSW, LCSW, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 MILLBURN AVE STE 101
MILLBURN NJ
07041-1941
US

IV. Provider business mailing address

96 MILLBURN AVE STE 101
MILLBURN NJ
07041-1941
US

V. Phone/Fax

Practice location:
  • Phone: 973-913-4385
  • Fax:
Mailing address:
  • Phone: 973-913-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120079-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14217101-3501
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06468000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: