Provider Demographics
NPI:1841508082
Name:LOVE, REBECCA MONICA (LCSW-R)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MONICA
Last Name:LOVE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1017
Mailing Address - Country:US
Mailing Address - Phone:315-769-8441
Mailing Address - Fax:315-769-3902
Practice Address - Street 1:23 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1017
Practice Address - Country:US
Practice Address - Phone:315-769-8441
Practice Address - Fax:315-769-3902
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05448411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical