Provider Demographics
NPI:1265500904
Name:TRAUTMANN, REBECCA LU (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LU
Last Name:TRAUTMANN
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 1:433 KENT CORNWALL RD UNIT 14
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-1212
Mailing Address - Country:US
Mailing Address - Phone:860-927-3313
Mailing Address - Fax:
Practice Address - Street 1:433 KENT CORNWALL RD
Practice Address - Street 2:UNIT 14
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1212
Practice Address - Country:US
Practice Address - Phone:860-592-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007291041C0700X
NY070278-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP970179OtherOXFORD HEALTH CARE
NY02489509Medicaid
NY02489509Medicaid