Provider Demographics
NPI:1871223487
Name:VERVILLE, REBECCA L (LMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:VERVILLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9183
Mailing Address - Country:US
Mailing Address - Phone:231-330-4856
Mailing Address - Fax:
Practice Address - Street 1:5 W MAIN ST UNIT 3
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-3700
Practice Address - Country:US
Practice Address - Phone:231-881-5001
Practice Address - Fax:231-344-6100
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010940261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical