Provider Demographics
NPI:1952075491
Name:NEAL, REBECCA AVERY (LSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:AVERY
Last Name:NEAL
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 STATESBORO RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3312
Mailing Address - Country:US
Mailing Address - Phone:937-207-0027
Mailing Address - Fax:
Practice Address - Street 1:10925 REED HARTMAN HWY
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2836
Practice Address - Country:US
Practice Address - Phone:937-907-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.22075831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical