Provider Demographics
NPI:1053480871
Name:WARD, RACHEL MARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARY
Last Name:WARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BARONY LN
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-5500
Mailing Address - Country:US
Mailing Address - Phone:815-354-7527
Mailing Address - Fax:833-901-2941
Practice Address - Street 1:68 BARONY LN
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-5500
Practice Address - Country:US
Practice Address - Phone:815-354-7527
Practice Address - Fax:833-901-2941
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1517103TC0700X
IL103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20-1026226OtherTAX IDENTIFICATION NUMBER
IL10132114OtherBLUE CROSS BLUE SHIELD