Provider Demographics
NPI:1386119121
Name:COOPER, REBECCA SUSAN KITCHIN (LCSW-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUSAN KITCHIN
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:PA
Mailing Address - Zip Code:17314-9475
Mailing Address - Country:US
Mailing Address - Phone:443-876-7912
Mailing Address - Fax:
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3539
Practice Address - Country:US
Practice Address - Phone:888-333-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD161381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical