Provider Demographics
NPI:1972060846
Name:REHAK, MATTHEW MCLEOD (LMSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MCLEOD
Last Name:REHAK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 PAPER MILL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1854
Mailing Address - Country:US
Mailing Address - Phone:443-386-2843
Mailing Address - Fax:
Practice Address - Street 1:825 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2964
Practice Address - Country:US
Practice Address - Phone:410-887-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD233891041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool