Healthcare Provider Details

I. General information

NPI: 1700420023
Provider Name (Legal Business Name): RACHAEL ELIZABETH AMOR MASTERS IN SOCIAL WO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 E JEFFERSON BLVD
SOUTH BEND IN
46615-3052
US

IV. Provider business mailing address

3006 LINCOLNWAY E
MISHAWAKA IN
46544-3501
US

V. Phone/Fax

Practice location:
  • Phone: 866-486-9769
  • Fax:
Mailing address:
  • Phone: 574-252-7233
  • Fax: 844-361-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: