Provider Demographics
NPI:1043617319
Name:ROBISON, REBECCA BURKETT (LICSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:BURKETT
Last Name:ROBISON
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 LITTLE LEIGH CT
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1625
Mailing Address - Country:US
Mailing Address - Phone:917-880-8353
Mailing Address - Fax:
Practice Address - Street 1:6408 LITTLE LEIGH CT
Practice Address - Street 2:
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1625
Practice Address - Country:US
Practice Address - Phone:917-880-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27956104100000X, 104100000X
DCLC500819281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical