Provider Demographics
NPI:1922292986
Name:VANDENBURGH, REBECCA (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:VANDENBURGH
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 1:2805 SUNNYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-3100
Mailing Address - Country:US
Mailing Address - Phone:317-522-7406
Mailing Address - Fax:
Practice Address - Street 1:5101 E. US HWY 36
Practice Address - Street 2:SUITE 100
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123
Practice Address - Country:US
Practice Address - Phone:317-745-9555
Practice Address - Fax:317-745-9565
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005310A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical