Provider Demographics
NPI:1114360633
Name:GOLDWASSER, RACHEL (MED BCBA)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:GOLDWASSER
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2518
Mailing Address - Country:US
Mailing Address - Phone:302-598-1214
Mailing Address - Fax:
Practice Address - Street 1:1418 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2518
Practice Address - Country:US
Practice Address - Phone:302-598-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1-12-11545103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst