Healthcare Provider Details

I. General information

NPI: 1356168025
Provider Name (Legal Business Name): EMILY REBELO LCSW, AADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FAIRMONT AVE
FAIRMONT WV
26554-2710
US

IV. Provider business mailing address

207 FAIRMONT AVE
FAIRMONT WV
26554-2710
US

V. Phone/Fax

Practice location:
  • Phone: 681-404-6869
  • Fax: 681-404-6871
Mailing address:
  • Phone: 681-404-6869
  • Fax: 681-404-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW139619
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCP00946772
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: