Basic Information
Provider Information
NPI: 1740316355
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: REBECCA
MiddleName: ANNE
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 405 W 5TH ST
Address2: STE. 550
City: SANTA ANA
State: CA
PostalCode: 927014599
CountryCode: US
TelephoneNumber: 7148344707
FaxNumber:  
Practice Location
Address1: 405 W 5TH ST
Address2: STE. 550
City: SANTA ANA
State: CA
PostalCode: 927014599
CountryCode: US
TelephoneNumber: 7148344707
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/26/2007
LastUpdateDate: 12/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XLCS 23946CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home