Provider Demographics
NPI:1689612863
Name:STANFORD, REBECCA E (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:STANFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-604-3170
Mailing Address - Fax:405-948-2745
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:SUITE 950
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-604-3170
Practice Address - Fax:405-948-2745
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical