Healthcare Provider Details

I. General information

NPI: 1700292695
Provider Name (Legal Business Name): RACHEL JUAIRE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

6 RAINONE CT
COVENTRY RI
02816-8728
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-2500
  • Fax:
Mailing address:
  • Phone: 401-397-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW01877
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02982
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: