Provider Demographics
NPI:1487952594
Name:URIG, REBECCA L (LISW-S)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:URIG
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MIDWAY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-9006
Mailing Address - Country:US
Mailing Address - Phone:440-723-5501
Mailing Address - Fax:440-324-9978
Practice Address - Street 1:347 MIDWAY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-9006
Practice Address - Country:US
Practice Address - Phone:440-723-5501
Practice Address - Fax:440-324-9978
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 0009962-SUPV1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical