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General NPI Number Information
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NPI Number | 1972005205
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Entity Type | Individual
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Provider Name | REBECCA K TANGEN LCSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 307 ROGERS AVE
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City | BROOKLYN
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State | NY
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Zip | 11225-2712
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Country | US
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Telephone | 646-305-1858
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Fax |
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Provider Business Mailing Address
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Address Line | 307 ROGERS AVE
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City | BROOKLYN
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State | NY
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Zip | 11225-2712
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Country | US
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Telephone | 646-305-1858
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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 | CSW.09929814
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | MBTSWO-43924
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW1121329
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089490
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License Number State | NY
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