=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124494695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHAEL OSETKOWSKI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2015
-----------------------------------------------------
Last Update Date | 12/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 1ST ST APT 7
-----------------------------------------------------
City | KEYPORT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07735-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 848-228-0826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 1ST ST APT 7
-----------------------------------------------------
City | KEYPORT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07735-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 848-228-0826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05898100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------