Healthcare Provider Details

I. General information

NPI: 1558723650
Provider Name (Legal Business Name): SHANNON MARIE REBIEJO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 STEPTOE CIR
ELY NV
89301-2692
US

IV. Provider business mailing address

6 STEPTOE CIR
ELY NV
89301-2692
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-3612
  • Fax: 775-289-6423
Mailing address:
  • Phone: 775-289-3612
  • Fax: 775-289-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8232-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: