Provider Demographics
NPI:1407985799
Name:DALTON, REBECCA ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:DALTON
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 1:504 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4261
Mailing Address - Country:US
Mailing Address - Phone:202-232-9100
Mailing Address - Fax:
Practice Address - Street 1:2607 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1522
Practice Address - Country:US
Practice Address - Phone:202-232-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC38268961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ1490001Medicare UPIN