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NPI Code Detail

MEDICARE: RACHEL ODONNELL

MEDICARE: RACHEL ODONNELL
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
1101Y00000XCounselor096226NY

General Provider Information

NPI Number : 1912554882
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL ODONNELL
Provider Business Mailing Address
First Line : 1650 SYCAMORE AVE STE 39
Second Line :
City : BOHEMIA
State : NY
Zip : 11716-1736
Country : US
Telephone Number : 631-219-5163
Fax Number :
Provider Business Practice Location Address
First Line : 1650 SYCAMORE AVE STE 39
Second Line :
City : BOHEMIA
State : NY
Zip : 11716-1736
Country : US
Telephone Number : 631-219-5163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2019
Last Update Date : 08/24/2019

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Directions to “ RACHEL ODONNELL ” Practice Location

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