Healthcare Provider Details

I. General information

NPI: 1639655731
Provider Name (Legal Business Name): RACHEL DALE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NIGHTINGALE RD
EDWARDS CA
93524-0001
US

IV. Provider business mailing address

30 NIGHTINGALE RD
EDWARDS CA
93524-0001
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-5291
  • Fax:
Mailing address:
  • Phone: 661-277-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851102948
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: