Provider Demographics
NPI:1033370747
Name:REBENSTOCK, LAUREL JEAN (LMSW, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:JEAN
Last Name:REBENSTOCK
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:MISS
Other - First Name:LAUREL
Other - Middle Name:JEAN
Other - Last Name:REBENSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAAC
Mailing Address - Street 1:5600 W MAPLE RD STE B212
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3787
Mailing Address - Country:US
Mailing Address - Phone:248-605-5049
Mailing Address - Fax:
Practice Address - Street 1:5600 W MAPLE RD STE B212
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3787
Practice Address - Country:US
Practice Address - Phone:248-605-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical