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General NPI Number Information
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NPI Number | 1184880080
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Entity Type | Individual
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Provider Name | REBECCA LARACUENTE LISW
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Gender | Female
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 5700 PEARL RD
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City | PARMA
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State | OH
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Zip | 44129-2537
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Country | US
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Telephone | 440-845-5023
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Fax |
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Provider Business Mailing Address
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Address Line | 370 WALNUT DR
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City | BEREA
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State | OH
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Zip | 44017-1355
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Country | US
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Telephone | 440-891-1953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I10198
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License Number State | OH
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