Healthcare Provider Details

I. General information

NPI: 1780415463
Provider Name (Legal Business Name): REBECCA OELKERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KALISA WAY
PARAMUS NJ
07652-3516
US

IV. Provider business mailing address

1 KALISA WAY
PARAMUS NJ
07652-3516
US

V. Phone/Fax

Practice location:
  • Phone: 201-788-7256
  • Fax:
Mailing address:
  • Phone: 201-788-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05414400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: