Provider Demographics
NPI:1972001543
Name:MARKONNI, REBECCA (LLMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MARKONNI
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32250 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1736
Mailing Address - Country:US
Mailing Address - Phone:734-709-2301
Mailing Address - Fax:
Practice Address - Street 1:33505 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1630
Practice Address - Country:US
Practice Address - Phone:844-296-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011005641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical