MEDICARE: RACHEL DIMONT

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	1041C0700X	Clinical Social Worker
2	104100000X	Social Worker	104743	NY

General Provider Information

NPI Number	:	1508518234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL DIMONT

Provider Business Mailing Address
First Line	:	6511 DYKES WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6511 DYKES WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1929
Country	:	US
Telephone Number	:	619-672-6839
Fax Number	:

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

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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Directions to “ RACHEL DIMONT ” Practice Location

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