Healthcare Provider Details

I. General information

NPI: 1134280332
Provider Name (Legal Business Name): RACHEL C EIDELMAN M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 PASSMORE DR
WILMINGTON DE
19803-1548
US

IV. Provider business mailing address

117 SUN CT
NEWARK DE
19711-3413
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-9411
  • Fax: 302-479-9883
Mailing address:
  • Phone: 302-239-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000821
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: