Provider Demographics
NPI:1225538325
Name:DANIELS, REBECCA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:OBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 HUTTLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1958
Mailing Address - Country:US
Mailing Address - Phone:508-996-0364
Mailing Address - Fax:508-996-0814
Practice Address - Street 1:216 HUTTLESTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-1958
Practice Address - Country:US
Practice Address - Phone:508-996-0364
Practice Address - Fax:508-996-0814
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1209481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty