Provider Demographics
NPI:1043075468
Name:CONIGLIO, REBECCA P (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:P
Last Name:CONIGLIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1908
Mailing Address - Country:US
Mailing Address - Phone:973-568-6453
Mailing Address - Fax:
Practice Address - Street 1:48 MARION AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1908
Practice Address - Country:US
Practice Address - Phone:973-568-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22SC05154900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor