Provider Demographics
NPI:1184880080
Name:LARACUENTE, REBECCA (LISW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:LARACUENTE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1355
Mailing Address - Country:US
Mailing Address - Phone:440-891-1953
Mailing Address - Fax:
Practice Address - Street 1:5700 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2537
Practice Address - Country:US
Practice Address - Phone:440-845-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI101981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical