Provider Demographics
NPI:1831433085
Name:INNELL, REBECCA REGAN (MSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:REGAN
Last Name:INNELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SHORE LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4221
Mailing Address - Country:US
Mailing Address - Phone:321-591-9943
Mailing Address - Fax:
Practice Address - Street 1:230 SHORE LN
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4221
Practice Address - Country:US
Practice Address - Phone:321-591-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor