Provider Demographics
NPI:1710242748
Name:CHARLES, REBECCA M (LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 N DUKE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2732
Mailing Address - Country:US
Mailing Address - Phone:717-917-3658
Mailing Address - Fax:
Practice Address - Street 1:2421 WILLOW STREET PIKE N
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9225
Practice Address - Country:US
Practice Address - Phone:717-464-0621
Practice Address - Fax:717-464-0890
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129634104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker