Provider Demographics
NPI:1013397330
Name:WAXMAN, REBECCA BERLIN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:BERLIN
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SHERMAN
Other - Last Name:BERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:1001 LAWRENCE ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3513
Mailing Address - Country:US
Mailing Address - Phone:202-635-5944
Mailing Address - Fax:
Practice Address - Street 1:1001 LAWRENCE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3513
Practice Address - Country:US
Practice Address - Phone:202-635-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500804611041C0700X
DCLG50080058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker