Provider Demographics
NPI:1780086421
Name:REBECCA THORNE STASCH, LLC
Entity type:Organization
Organization Name:REBECCA THORNE STASCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:THORNE
Authorized Official - Last Name:STASCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:770-235-2398
Mailing Address - Street 1:5002 W HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7521
Mailing Address - Country:US
Mailing Address - Phone:770-235-2398
Mailing Address - Fax:
Practice Address - Street 1:3825 HENDERSON BLVD STE 405
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5012
Practice Address - Country:US
Practice Address - Phone:813-803-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW8882104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty