Provider Demographics
NPI:1437201019
Name:KIERSZNOWSKI, REBECCA ANNE (MSW, CCDC, CCDP-D)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:KIERSZNOWSKI
Suffix:
Gender:F
Credentials:MSW, CCDC, CCDP-D
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:ARBOGAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CCDC
Mailing Address - Street 1:305 MAIN ST.
Mailing Address - Street 2:PO BOX 294
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734
Mailing Address - Country:US
Mailing Address - Phone:410-996-5104
Mailing Address - Fax:410-996-5197
Practice Address - Street 1:200 BOOTH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5657
Practice Address - Country:US
Practice Address - Phone:410-996-5104
Practice Address - Fax:410-996-5197
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1445101YA0400X
MD117521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD922801200Medicaid
MD922801200Medicaid