Healthcare Provider Details

I. General information

NPI: 1356322069
Provider Name (Legal Business Name): RACHEL LYNN GRAHN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL LYNN HERTEL LCSW

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 ROUTE 55 STE 11
LAGRANGEVILLE NY
12540-5052
US

IV. Provider business mailing address

14 SHERMAN RD
NEW MILFORD CT
06776-5701
US

V. Phone/Fax

Practice location:
  • Phone: 516-477-1484
  • Fax: 845-471-2223
Mailing address:
  • Phone: 516-477-1484
  • Fax: 845-471-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number064294-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075557-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: