Provider Demographics
NPI:1689934424
Name:PALEN, REBECCA L (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:PALEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22811 GREATER MACK AVE STE L2
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2057
Mailing Address - Country:US
Mailing Address - Phone:586-335-2006
Mailing Address - Fax:586-279-3886
Practice Address - Street 1:22811 GREATER MACK AVENUE, STE L2
Practice Address - Street 2:
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080
Practice Address - Country:US
Practice Address - Phone:586-335-2006
Practice Address - Fax:586-279-3886
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010866441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical