Provider Demographics
NPI:1780325795
Name:ANDERSON, REBECCA FORTSON (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:FORTSON
Last Name:ANDERSON
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 1:233 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3879
Mailing Address - Country:US
Mailing Address - Phone:972-693-6618
Mailing Address - Fax:
Practice Address - Street 1:25 STATE AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4420
Practice Address - Country:US
Practice Address - Phone:717-220-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8497-1231041C0700X
PACW0202471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical