Provider Demographics
NPI:1922217587
Name:EVANS, RACHEL K (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:K
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 RIVERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5123
Mailing Address - Country:US
Mailing Address - Phone:845-481-0049
Mailing Address - Fax:
Practice Address - Street 1:93 RIVERVIEW CT
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5123
Practice Address - Country:US
Practice Address - Phone:845-481-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044582-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNC2831Medicare ID - Type Unspecified