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General NPI Number Information
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NPI Number | 1730542952
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Entity Type | Individual
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Provider Name | MICHELLE MARIE RABBAS LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 10/16/2021
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Provider Practice Location Address
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Address Line | 1418 MAIN ST STE 207
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City | PECKVILLE
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State | PA
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Zip | 18452-2050
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Country | US
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Telephone | 570-277-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 MAIN ST APT 1L
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City | DICKSON CITY
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State | PA
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Zip | 18519-1341
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Country | US
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Telephone | 570-498-1257
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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 | CW020068
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License Number State | PA
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