Healthcare Provider Details

I. General information

NPI: 1780110106
Provider Name (Legal Business Name): RACHAEL AROWOLO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL BOWLER PHD

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 SHADY GROVE RD STE 350
ROCKVILLE MD
20850-6237
US

IV. Provider business mailing address

5316 DISNEY AVE
BROOKLYN MD
21225-3143
US

V. Phone/Fax

Practice location:
  • Phone: 301-765-5430
  • Fax:
Mailing address:
  • Phone: 716-868-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number06909
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCG60608192
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: