Provider Demographics
NPI:1356830764
Name:HEBRANK, REESE MORDECHAI (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:REESE
Middle Name:MORDECHAI
Last Name:HEBRANK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 AMBER LEAF PL APT T5
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2158
Mailing Address - Country:US
Mailing Address - Phone:240-249-5891
Mailing Address - Fax:
Practice Address - Street 1:601 POST OFFICE RD STE 2D
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1912
Practice Address - Country:US
Practice Address - Phone:301-910-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23423104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty