Provider Demographics
NPI:1134550866
Name:DEMATTIA, REBECCA (LGSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DEMATTIA
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S LYNCHBURG ST STE D
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1128
Mailing Address - Country:US
Mailing Address - Phone:443-331-4708
Mailing Address - Fax:
Practice Address - Street 1:114 S LYNCHBURG ST STE D
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1128
Practice Address - Country:US
Practice Address - Phone:443-331-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16141104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker