Provider Demographics
NPI:1427136431
Name:NELIS, REBECCA ANN (LISW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:NELIS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MALIBU DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413
Mailing Address - Country:US
Mailing Address - Phone:330-501-5111
Mailing Address - Fax:
Practice Address - Street 1:611 BELMONT AVENUE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502
Practice Address - Country:US
Practice Address - Phone:330-144-2991
Practice Address - Fax:330-744-2971
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0500051104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2223084OtherCIGNA BEHAVIORAL
OH834493000OtherMAGELLAN MIS
OH000000336260OtherANTHEM BCBS