Provider Demographics
NPI:1205026598
Name:REBACH, HOWARD MARTIN (LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARTIN
Last Name:REBACH
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:DR
Other - First Name:HOWARD
Other - Middle Name:MARTIN
Other - Last Name:REBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, PHD
Mailing Address - Street 1:540 RIVERSIDE DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5352
Mailing Address - Country:US
Mailing Address - Phone:410-726-5578
Mailing Address - Fax:
Practice Address - Street 1:540 RIVERSIDE DR
Practice Address - Street 2:SUITE #2
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5352
Practice Address - Country:US
Practice Address - Phone:410-726-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD065541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD159381100Medicaid