MEDICARE: MS. REBECCA LAND LCSW

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	098978	NY

General Provider Information

NPI Number	:	1629749874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA LAND LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1196
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-1196
Country	:	US
Telephone Number	:	917-861-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 W 72ND ST APT 11F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-3215
Country	:	US
Telephone Number	:	917-861-0088
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	12/18/2024

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