Healthcare Provider Details

I. General information

NPI: 1659030393
Provider Name (Legal Business Name): RACHEL O'SULLIVAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 RIVERVIEW AVE
WAUKESHA WI
53188-3631
US

IV. Provider business mailing address

514 RIVERVIEW AVE
WAUKESHA WI
53188-3631
US

V. Phone/Fax

Practice location:
  • Phone: 262-548-7666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12716-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: