Provider Demographics
NPI:1992039853
Name:SHACKNEY, REBEKAH LEIBE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LEIBE
Last Name:SHACKNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:55 WALGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2311
Mailing Address - Country:US
Mailing Address - Phone:917-721-2257
Mailing Address - Fax:
Practice Address - Street 1:85 HOPPER AVE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1517
Practice Address - Country:US
Practice Address - Phone:917-721-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054041001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical