Provider Demographics
NPI:1518002369
Name:WERNSING, REBA GAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:REBA
Middle Name:GAIL
Last Name:WERNSING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 PUTNAM ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13480-1212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1643 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4733
Practice Address - Country:US
Practice Address - Phone:315-724-5173
Practice Address - Fax:315-724-5323
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040714-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6245537OtherUNITED BEHAVIORAL HEALTH
NY143478OtherVALUE OPTIONS
NY070209000090OtherFIDELIS CARE NEW YORK
NY143478OtherVALUE OPTIONS