Provider Demographics
NPI:1750738480
Name:FRELE, REBECCA (LICSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FRELE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COMMERCIAL ST STE 3004
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1118
Mailing Address - Country:US
Mailing Address - Phone:603-668-3050
Mailing Address - Fax:
Practice Address - Street 1:250 COMMERCIAL ST STE 3004
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1118
Practice Address - Country:US
Practice Address - Phone:603-668-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089637104100000X
NH20411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker