Provider Demographics
NPI:1720875842
Name:ELLIOTT, REBECCA JOLENE (MSW, RCSWI)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOLENE
Last Name:ELLIOTT
Suffix:
Gender:
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 GILMORE AVE APT 62
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-1895
Mailing Address - Country:US
Mailing Address - Phone:813-365-8351
Mailing Address - Fax:
Practice Address - Street 1:4435 FLORIDA NATIONAL DR STE B
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1516
Practice Address - Country:US
Practice Address - Phone:863-216-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW20688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health