Provider Demographics
NPI:1073608816
Name:SAM-MCCAGHREN, REBECCA JOY (LCSW LICENSED CLINIC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JOY
Last Name:SAM-MCCAGHREN
Suffix:
Gender:F
Credentials:LCSW LICENSED CLINIC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SAM-MCCAGHREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:10000 STIRLING RD
Mailing Address - Street 2:6
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-436-8326
Mailing Address - Fax:954-433-0603
Practice Address - Street 1:10000 STIRLING RD
Practice Address - Street 2:6
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-436-8326
Practice Address - Fax:954-433-0603
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00028071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical