MEDICARE: RACHEL A CALABRESE MA, LAC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37AC00413300	NJ

General Provider Information

NPI Number	:	1447801675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL A CALABRESE MA, LAC, NCC

Provider Business Mailing Address
First Line	:	62 JAY DR
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2320
Country	:	US
Telephone Number	:	551-206-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 W ALLENDALE AVE
Second Line	:	FL 2, SUITE D
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-1798
Country	:	US
Telephone Number	:	201-574-8522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2019
Last Update Date	:	09/29/2019

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