Provider Demographics
NPI:1083628945
Name:MODIANO, RACHEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:MODIANO
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 1:710 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1855
Mailing Address - Country:US
Mailing Address - Phone:732-828-4622
Mailing Address - Fax:732-828-0255
Practice Address - Street 1:710 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1855
Practice Address - Country:US
Practice Address - Phone:732-828-4622
Practice Address - Fax:732-828-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100248000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMO633583Medicare ID - Type Unspecified