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General NPI Number Information
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NPI Number | 1164757654
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Entity Type | Individual
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Provider Name | SHANA HEATHER RACKMILL LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 282 WASHINGTON ST
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City | HARTFORD
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State | CT
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Zip | 06106-3322
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Country | US
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Telephone | 860-837-5560
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Fax |
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Provider Business Mailing Address
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Address Line | 181 W MOUNTAIN RD
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City | WEST SIMSBURY
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State | CT
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Zip | 06092-2619
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Country | US
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Telephone | 860-836-0891
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 214862
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11312
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License Number State | CT
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