Provider Demographics
NPI:1366143646
Name:NIEDRIST, RACHEL LEEANN (MSS, LCSW)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LEEANN
Last Name:NIEDRIST
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N MAIN ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1799
Mailing Address - Country:US
Mailing Address - Phone:267-354-0113
Mailing Address - Fax:
Practice Address - Street 1:121 N MAIN ST STE 310
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1799
Practice Address - Country:US
Practice Address - Phone:267-354-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0221711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical