Healthcare Provider Details

I. General information

NPI: 1770868143
Provider Name (Legal Business Name): RACHEL FAIELLA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MATTEAWAN RD
BEACON NY
12508-1571
US

IV. Provider business mailing address

30 OVERLOOK AVE
BEACON NY
12508-2636
US

V. Phone/Fax

Practice location:
  • Phone: 845-838-6900
  • Fax:
Mailing address:
  • Phone: 845-838-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number075987
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: