Healthcare Provider Details

I. General information

NPI: 1033867585
Provider Name (Legal Business Name): RACHEL WEINTRAUB LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 BURBANK AVE
SUFFIELD CT
06078-1459
US

IV. Provider business mailing address

31 SETTLERS WAY
ELLINGTON CT
06029-3651
US

V. Phone/Fax

Practice location:
  • Phone: 860-758-7564
  • Fax:
Mailing address:
  • Phone: 860-604-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5954
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: