Healthcare Provider Details

I. General information

NPI: 1720373780
Provider Name (Legal Business Name): JENNIFER R RABADY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 CASTOR AVE
PHILADELPHIA PA
19152-2729
US

IV. Provider business mailing address

8220 CASTOR AVENUE
PHILADELPHIA PA
19152-2729
US

V. Phone/Fax

Practice location:
  • Phone: 215-554-4489
  • Fax: 267-350-4887
Mailing address:
  • Phone: 215-554-4489
  • Fax: 267-350-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1041C0700X
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: