Healthcare Provider Details

I. General information

NPI: 1093397069
Provider Name (Legal Business Name): RACHAEL MARIE MEDEIROS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S MAIN ST
FALL RIVER MA
02721-5375
US

IV. Provider business mailing address

341 CENTRAL AVE
NEW BEDFORD MA
02745-5043
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-1740
  • Fax: 508-484-2528
Mailing address:
  • Phone: 508-858-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126897
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: