MEDICARE: REBECCA SCHAFFNER THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1154906790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBECCA SCHAFFNER THERAPY, LLC

Provider Business Mailing Address
First Line	:	938 E SWAN CREEK RD STE 408
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5250
Country	:	US
Telephone Number	:	443-868-8574
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 WASHINGTON OVERLOOK DR
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-1449
Country	:	US
Telephone Number	:	443-868-8574
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	REBECCA MARIA SCHAFFNER
Credential	:	LCPC
Telephone Number	:	443-558-6640

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/30/2021

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