Provider Demographics
NPI:1275759102
Name:PRINE, REBECCA A (MSW INTERN)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:PRINE
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9754 HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:DESCANSO
Mailing Address - State:CA
Mailing Address - Zip Code:91916-9771
Mailing Address - Country:US
Mailing Address - Phone:323-697-0001
Mailing Address - Fax:
Practice Address - Street 1:4018 CITY TERRACE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-1242
Practice Address - Country:US
Practice Address - Phone:323-268-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29890104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker