Provider Demographics
NPI:1538226634
Name:VAN DELLEN, REBECCA JOY (MSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOY
Last Name:VAN DELLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 SHAUNA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2952
Mailing Address - Country:US
Mailing Address - Phone:904-783-2579
Mailing Address - Fax:
Practice Address - Street 1:6316 SAN JUAN AVE
Practice Address - Street 2:SUITE 41
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2831
Practice Address - Country:US
Practice Address - Phone:904-783-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical