Healthcare Provider Details

I. General information

NPI: 1255177663
Provider Name (Legal Business Name): DR. RACHELL PIERRE-LOUIS, PSYCHOLOGIST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 WANTAGH AVE STE 103
WANTAGH NY
11793-3925
US

IV. Provider business mailing address

2175 WANTAGH AVE STE 103
WANTAGH NY
11793-3925
US

V. Phone/Fax

Practice location:
  • Phone: 631-392-8245
  • Fax:
Mailing address:
  • Phone: 631-392-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHELL PIERRE-LOUIS
Title or Position: PRESIDENT
Credential: PSY.D
Phone: 631-392-8245