Healthcare Provider Details

I. General information

NPI: 1528771847
Provider Name (Legal Business Name): RACHEL MONGE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W BOYLSTON DR
WORCESTER MA
01606-2788
US

IV. Provider business mailing address

18 RENA ST # 3
WORCESTER MA
01604-6008
US

V. Phone/Fax

Practice location:
  • Phone: 508-793-8000
  • Fax:
Mailing address:
  • Phone: 203-907-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123381
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: