Provider Demographics
NPI:1043223001
Name:CHANDLER, REBECCA B (LCSW-C)
Entity Type:Individual
Prefix:PROF
First Name:REBECCA
Middle Name:B
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:B
Other - Last Name:BOUDREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1731 GABLEHAMMER RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3953
Mailing Address - Country:US
Mailing Address - Phone:410-825-2281
Mailing Address - Fax:410-825-0757
Practice Address - Street 1:1407 YORK RD
Practice Address - Street 2:SUITE 309
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6097
Practice Address - Country:US
Practice Address - Phone:410-825-2281
Practice Address - Fax:410-825-0757
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06615104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD361LL619Medicare ID - Type Unspecified