Provider Demographics
NPI:1669519104
Name:SAXANOFF, REBEKAH (LCSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:SAXANOFF
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 1:790 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5202
Mailing Address - Country:US
Mailing Address - Phone:252-259-5419
Mailing Address - Fax:252-636-1100
Practice Address - Street 1:790 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5202
Practice Address - Country:US
Practice Address - Phone:252-259-5419
Practice Address - Fax:252-636-1100
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002852Medicaid
NC13686OtherBCBS
NC6002852Medicaid