Healthcare Provider Details

I. General information

NPI: 1003693847
Provider Name (Legal Business Name): RACHAEL KIRI MILLER BAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N MAIN ST
LEEDS MA
01053-9700
US

IV. Provider business mailing address

421 N MAIN ST
LEEDS MA
01053-9700
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-4040
  • Fax: 413-731-6062
Mailing address:
  • Phone: 413-584-4040
  • Fax: 413-731-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2141627
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: