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General NPI Number Information
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NPI Number | 1639883374
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Entity Type | Individual
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Provider Name | RACHEL AYLSWORTH LMHC, BC-DMT
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Gender | Female
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 22 MOUNT AUBURN ST
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City | WATERTOWN
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State | MA
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Zip | 02472-3992
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Country | US
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Telephone | 225-572-1460
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MELBOURNE AVE
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City | NEWTON
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State | MA
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Zip | 02460-1221
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12404
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | 12404
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License Number State | MA
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