MEDICARE: REBECCA MOREHISER

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	11727601	NY

General Provider Information

NPI Number	:	1609538149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MOREHISER

Provider Business Mailing Address
First Line	:	18 COMMERCE ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-3761
Country	:	US
Telephone Number	:	201-430-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 KEAP ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3433
Country	:	US
Telephone Number	:	929-374-2436
Fax Number	:

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

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	09/23/2022

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