Provider Demographics
NPI:1033686621
Name:GOLDSTEIN, RACHEL ESTHER (LMSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ESTHER
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 KEWANEE WAY
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2518
Mailing Address - Country:US
Mailing Address - Phone:248-798-3025
Mailing Address - Fax:
Practice Address - Street 1:204 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2070
Practice Address - Country:US
Practice Address - Phone:734-478-7358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI68011094921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program