Provider Demographics
NPI:1255493904
Name:GESSOW, REBECCA (LICSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GESSOW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705A OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-1819
Mailing Address - Country:US
Mailing Address - Phone:401-364-7705
Mailing Address - Fax:401-364-9104
Practice Address - Street 1:4705A OLD POST RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-1819
Practice Address - Country:US
Practice Address - Phone:401-364-7705
Practice Address - Fax:401-364-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW009641041C0700X
MA1076861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical