Provider Demographics
NPI:1164915161
Name:NEARY, REBECCA (LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NEARY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12968 HARDIN PIKE
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-8323
Mailing Address - Country:US
Mailing Address - Phone:937-267-6748
Mailing Address - Fax:
Practice Address - Street 1:1001 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1331
Practice Address - Country:US
Practice Address - Phone:937-267-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.13024451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical