Healthcare Provider Details

I. General information

NPI: 1366039554
Provider Name (Legal Business Name): RACHEL KLINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 RIVERDALE AVE # 1A
BRONX NY
10471-1032
US

IV. Provider business mailing address

3 WOODVIEW WAY
HAMPTON BAYS NY
11946-1114
US

V. Phone/Fax

Practice location:
  • Phone: 718-701-4807
  • Fax:
Mailing address:
  • Phone: 631-903-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: