Provider Demographics
NPI:1710055777
Name:CULJAT, REBECCA DIANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DIANNE
Last Name:CULJAT
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 1:518 PEACH WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-6890
Mailing Address - Country:US
Mailing Address - Phone:460-798-7244
Mailing Address - Fax:
Practice Address - Street 1:4660 VIEWRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1638
Practice Address - Country:US
Practice Address - Phone:858-292-1055
Practice Address - Fax:858-292-0669
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical