Provider Demographics
NPI:1417933045
Name:REHNERT, JOHN L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:REHNERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 RED HORSE RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8724
Mailing Address - Country:US
Mailing Address - Phone:570-622-5601
Mailing Address - Fax:570-628-9051
Practice Address - Street 1:16 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3001
Practice Address - Country:US
Practice Address - Phone:570-628-5234
Practice Address - Fax:570-628-9051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0130671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA009270Medicare ID - Type Unspecified