MEDICARE: RACHEL LIVELY INCORPORATED

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	103TC0700X	Clinical Psychologist	8729	MA

General Provider Information

NPI Number	:	1336508217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RACHEL LIVELY INCORPORATED

Provider Business Mailing Address
First Line	:	25 MARKET ST
Second Line	:	SUITE 14
City	:	SWANSEA
State	:	MA
Zip	:	02777-3999
Country	:	US
Telephone Number	:	508-221-4844
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MARKET ST
Second Line	:	SUITE 14
City	:	SWANSEA
State	:	MA
Zip	:	02777-3999
Country	:	US
Telephone Number	:	508-221-4844
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	RACHEL LIVELY
Credential	:
Telephone Number	:	508-221-4844

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	02/19/2016

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