Healthcare Provider Details

I. General information

NPI: 1609407915
Provider Name (Legal Business Name): RACHEL MARIE CAVALLARO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST STE 320
HARTFORD CT
06106-3300
US

IV. Provider business mailing address

80 SEYMOUR ST STE 320
HARTFORD CT
06106-3300
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-4219
  • Fax:
Mailing address:
  • Phone: 860-972-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0005174
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number319684
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4257
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4257
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: