Provider Demographics
NPI:1770075483
Name:KERNS-WETHERINGTON, RACHAEL D (PSYD)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:D
Last Name:KERNS-WETHERINGTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:RACHAEL
Other - Middle Name:D
Other - Last Name:KERNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1900 E HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1108
Mailing Address - Country:US
Mailing Address - Phone:612-242-1787
Mailing Address - Fax:
Practice Address - Street 1:4617 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3836
Practice Address - Country:US
Practice Address - Phone:612-242-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5354103T00000X
PAPS017558103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist