Healthcare Provider Details

I. General information

NPI: 1215757661
Provider Name (Legal Business Name): RACHELLE DAGENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6657 OGONTZ AVE APT 3F
PHILADELPHIA PA
19126-2653
US

IV. Provider business mailing address

6657 OGONTZ AVE APT 3F
PHILADELPHIA PA
19126-2653
US

V. Phone/Fax

Practice location:
  • Phone: 484-529-4173
  • Fax:
Mailing address:
  • Phone: 484-529-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: