Provider Demographics
NPI:1093978769
Name:SIDEN, REBECCA A (MSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:SIDEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 ELM ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6344
Mailing Address - Country:US
Mailing Address - Phone:248-259-5502
Mailing Address - Fax:
Practice Address - Street 1:295 ELM ST STE 1
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6344
Practice Address - Country:US
Practice Address - Phone:248-259-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010893441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical