Healthcare Provider Details

I. General information

NPI: 1205664141
Provider Name (Legal Business Name): RACHEL MARIE MACK M.S. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N CENTRAL AVE STE 340A
HARTSDALE NY
10530-1952
US

IV. Provider business mailing address

3 N 2ND ST
CORTLANDT MANOR NY
10567-5278
US

V. Phone/Fax

Practice location:
  • Phone: 914-428-5151
  • Fax:
Mailing address:
  • Phone: 914-772-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number035612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: