Provider Demographics
NPI:1336229012
Name:SENZER, REBECCA WILLOW (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:WILLOW
Last Name:SENZER
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 1:1133 DUNBAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1409
Mailing Address - Country:US
Mailing Address - Phone:203-736-9549
Mailing Address - Fax:
Practice Address - Street 1:1133 DUNBAR HILL RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1409
Practice Address - Country:US
Practice Address - Phone:203-736-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004230413Medicaid