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General NPI Number Information
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NPI Number | 1346485273
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Entity Type | Individual
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Provider Name | RACHEL M YURDIN L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2008
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 1088 BLACK ROCK TPKE
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City | FAIRFIELD
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State | CT
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Zip | 06825-4107
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Country | US
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Telephone | 203-268-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 4 ALLEN DR
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City | TRUMBULL
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State | CT
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Zip | 06611-3702
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Country | US
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Telephone | 203-268-7070
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Fax | 203-334-4647
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 006392
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License Number State | CT
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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 | 006392
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License Number State | CT
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