Healthcare Provider Details

I. General information

NPI: 1104068683
Provider Name (Legal Business Name): AMORA RACHELLE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 W PARK AVE
EAST ATLANTIC BEACH NY
11561-1153
US

IV. Provider business mailing address

1223 W PARK AVE
EAST ATLANTIC BEACH NY
11561-1153
US

V. Phone/Fax

Practice location:
  • Phone: 516-477-3798
  • Fax: 516-889-2141
Mailing address:
  • Phone: 516-477-3798
  • Fax: 516-889-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberP6889
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP6889
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberP6889
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberP6889
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberP6889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: