Provider Demographics
NPI:1760636542
Name:SCANDELL, REBECCA SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUSAN
Last Name:SCANDELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:SUSAN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:76 JULIE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3007
Mailing Address - Country:US
Mailing Address - Phone:618-288-2811
Mailing Address - Fax:
Practice Address - Street 1:4 SCIENCE PARK
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1962
Practice Address - Country:US
Practice Address - Phone:184-483-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208564001Medicare UPIN