MEDICARE: DR. AMORA RACHELLE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	P6889	NY
2	103TC0700X	Clinical Psychologist	P6889	NY
3	103TF0000X	Family Psychologist	P6889	NY
4	103TH0004X	Health Psychologist	P6889	NY
5	103TP2701X	Group Psychotherapy Psychologist	P6889	NY

General Provider Information

NPI Number	:	1104068683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMORA RACHELLE PH.D.

Provider Business Mailing Address
First Line	:	1223 W PARK AVE
Second Line	:
City	:	EAST ATLANTIC BEACH
State	:	NY
Zip	:	11561-1153
Country	:	US
Telephone Number	:	516-477-3798
Fax Number	:	516-889-2141

Provider Business Practice Location Address
First Line	:	1223 W PARK AVE
Second Line	:
City	:	EAST ATLANTIC BEACH
State	:	NY
Zip	:	11561-1153
Country	:	US
Telephone Number	:	516-477-3798
Fax Number	:	516-889-2141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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