Healthcare Provider Details

I. General information

NPI: 1255483095
Provider Name (Legal Business Name): RACHEL D PAKENHAM MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 A LA GRANGE FLEMING CIRCLE
FREDERIKSTED VI
00841-0661
US

IV. Provider business mailing address

PO BOX 661
FREDERIKSTED VI
00841-0661
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-3327
  • Fax:
Mailing address:
  • Phone: 340-772-5209
  • Fax: 340-713-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002517
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2-2050103-2008
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: