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NPI Code Detail

MEDICARE: REBECCA ILYSE REIS LCSW-C

MEDICARE: REBECCA ILYSE REIS LCSW-C
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
11041C0700XClinical Social Worker15804CA
21041C0700XClinical Social Worker13854MD

General Provider Information

NPI Number : 1962564914
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ILYSE REIS LCSW-C
Provider Business Mailing Address
First Line : 6901 N CHARLES ST
Second Line :
City : TOWSON
State : MD
Zip : 21204-3780
Country : US
Telephone Number : 443-809-5024
Fax Number :
Provider Business Practice Location Address
First Line : 6901 N CHARLES ST
Second Line :
City : TOWSON
State : MD
Zip : 21204-3780
Country : US
Telephone Number : 443-809-5024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 01/10/2022

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Directions to “ REBECCA ILYSE REIS LCSW-C” Practice Location

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