Healthcare Provider Details

I. General information

NPI: 1659458081
Provider Name (Legal Business Name): RACHEL K AIZEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 NO PLEASANT ST SUITE 204
AMHERST MA
01002
US

IV. Provider business mailing address

48 NO PLEASANT ST SUITE 204
AMHERST MA
01002
US

V. Phone/Fax

Practice location:
  • Phone: 413-256-3456
  • Fax:
Mailing address:
  • Phone: 413-256-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberMA1485PSY
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier355181
Identifier TypeOTHER
Identifier State
Identifier IssuerMAGELLAN
# 2
IdentifierAIW01007
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 3
Identifier0503266
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: