Provider Demographics
NPI:1952075491
Name:NEAL, REBECCA AVERY (LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:AVERY
Last Name:NEAL
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 1:4790 RED BANK RD STE 216
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1509
Mailing Address - Country:US
Mailing Address - Phone:937-207-0027
Mailing Address - Fax:
Practice Address - Street 1:4790 RED BANK RD STE 216
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1509
Practice Address - Country:US
Practice Address - Phone:937-907-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.22075831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical