Provider Demographics
NPI:1134993884
Name:REIN, ROSALIE (LCSW)
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:REIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80262
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-0262
Mailing Address - Country:US
Mailing Address - Phone:907-378-1643
Mailing Address - Fax:907-921-5125
Practice Address - Street 1:3504 INDUSTRIAL AVE STE 216
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7902
Practice Address - Country:US
Practice Address - Phone:907-687-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2136841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical