Provider Demographics
NPI:1881676740
Name:ENGLE, REBECCA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:ENGLE
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:PO BOX 6049
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-1649
Mailing Address - Country:US
Mailing Address - Phone:727-517-3706
Mailing Address - Fax:
Practice Address - Street 1:2401 W BAY DR
Practice Address - Street 2:BLDG 100, STE 117
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4900
Practice Address - Country:US
Practice Address - Phone:727-517-3706
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00030891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5168OtherBLUE CROSS & BLUE SHIELD
FL065469OtherVALUE OPTIONS
FLZ5168Medicare ID - Type Unspecified