Provider Demographics
NPI:1326474354
Name:FOGEL, REBECCA (SOCIAL WORK STUDENT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:FOGEL
Suffix:
Gender:F
Credentials:SOCIAL WORK STUDENT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:FOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 SAINT JOHNS PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2690
Mailing Address - Country:US
Mailing Address - Phone:718-773-2080
Mailing Address - Fax:
Practice Address - Street 1:1055 SAINT JOHNS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2690
Practice Address - Country:US
Practice Address - Phone:718-773-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093365-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker