Provider Demographics
NPI:1336988120
Name:TEFERA, REBECCA (LSW, LCADC INTERN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TEFERA
Suffix:
Gender:F
Credentials:LSW, LCADC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 OCEAN PARK AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1484
Mailing Address - Country:US
Mailing Address - Phone:732-939-9277
Mailing Address - Fax:
Practice Address - Street 1:216 OCEAN PARK AVE APT 9
Practice Address - Street 2:
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720-1484
Practice Address - Country:US
Practice Address - Phone:732-939-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06855900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker