Provider Demographics
NPI:1073680005
Name:WACHS, RACHEL ANNE (CSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANNE
Last Name:WACHS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:BOSGANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:566 EAST PENN STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:516-889-2012
Mailing Address - Fax:
Practice Address - Street 1:80 LINCOLN AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-557-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0416361104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker