Provider Demographics
NPI:1427387083
Name:LEVENSON, REBECCA MELLEN (LICSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MELLEN
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MAUREEN
Other - Last Name:MELLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 TACOMA AVE S APT 29
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2506
Mailing Address - Country:US
Mailing Address - Phone:718-614-1613
Mailing Address - Fax:
Practice Address - Street 1:204 TACOMA AVE S APT 29
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2506
Practice Address - Country:US
Practice Address - Phone:718-614-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601883121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical