Provider Demographics
NPI:1033622360
Name:WROTNY, REBECCA (LCSW-C, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:WROTNY
Suffix:
Gender:F
Credentials:LCSW-C, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3003
Mailing Address - Country:US
Mailing Address - Phone:667-600-2494
Mailing Address - Fax:410-729-8496
Practice Address - Street 1:1111 BENFIELD BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-3003
Practice Address - Country:US
Practice Address - Phone:667-600-2494
Practice Address - Fax:410-729-8496
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty