MEDICARE: REBECCA RAYMOND GERHART

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1376893537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA RAYMOND GERHART

Provider Business Mailing Address
First Line	:	1110 MAIN ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2240
Country	:	US
Telephone Number	:	860-569-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 MAIN ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2240
Country	:	US
Telephone Number	:	860-569-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	08/09/2022

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