Healthcare Provider Details

I. General information

NPI: 1780325795
Provider Name (Legal Business Name): REBECCA FORTSON ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STATE AVE
CARLISLE PA
17013-4420
US

IV. Provider business mailing address

233 S WEST ST
CARLISLE PA
17013-3879
US

V. Phone/Fax

Practice location:
  • Phone: 717-220-8980
  • Fax:
Mailing address:
  • Phone: 972-693-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8497-123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020247
License Number StatePA

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: