Healthcare Provider Details

I. General information

NPI: 1841948049
Provider Name (Legal Business Name): RACHEL M DEPNER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL DEPNER

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST POTTER BUILDING, RHODE ISLAND HOSPITAL
PROVIDENCE RI
02903
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-2128
  • Fax:
Mailing address:
  • Phone: 401-444-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02085
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: