Healthcare Provider Details

I. General information

NPI: 1205649597
Provider Name (Legal Business Name): RACHEL FIUK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL CONDON

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST AVE
CHARLESTOWN MA
02129-3109
US

IV. Provider business mailing address

100 SUDBURY ST UNIT 3207
BOSTON MA
02114-2962
US

V. Phone/Fax

Practice location:
  • Phone: 617-952-5995
  • Fax:
Mailing address:
  • Phone: 201-956-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLICSW125724
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: