Provider Demographics
NPI:1003479767
Name:PARTRIDGE, RACHELLE MARY
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:MARY
Last Name:PARTRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DENISON PARKWAY WEST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2613
Mailing Address - Country:US
Mailing Address - Phone:607-937-4560
Mailing Address - Fax:607-937-3205
Practice Address - Street 1:209 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1124
Practice Address - Country:US
Practice Address - Phone:607-936-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094851104100000X
NY0950991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker