Healthcare Provider Details

I. General information

NPI: 1164512554
Provider Name (Legal Business Name): JENNIFER SPIVEY-RACHLIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BEACH ST BLDG. B UPPER LEVEL
WESTERLY RI
02891-2717
US

IV. Provider business mailing address

85 BEACH ST BLDG. B UPPER LEVEL
WESTERLY RI
02891-2717
US

V. Phone/Fax

Practice location:
  • Phone: 401-506-6866
  • Fax: 401-596-0493
Mailing address:
  • Phone: 401-506-6866
  • Fax: 401-596-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1SW1049
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: