Healthcare Provider Details

I. General information

NPI: 1033564885
Provider Name (Legal Business Name): RACHEL GOLDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAGUIRE RD
LEXINGTON MA
02421
US

IV. Provider business mailing address

1 MAGUIRE RD
LEXINGTON MA
02421-3114
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-1700
  • Fax:
Mailing address:
  • Phone: 617-966-6076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10986
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number000
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: