Provider Demographics
NPI:1518161876
Name:VAN HEDEN, REBECKA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECKA
Middle Name:LYNN
Last Name:VAN HEDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BECKIE
Other - Middle Name:LYNN
Other - Last Name:VAN HEDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21 W FEE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4476
Mailing Address - Country:US
Mailing Address - Phone:321-409-0256
Mailing Address - Fax:
Practice Address - Street 1:21 W FEE AVE STE C
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4476
Practice Address - Country:US
Practice Address - Phone:321-409-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW65531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical