Provider Demographics
NPI:1124188453
Name:KACSUR, RACHEL A (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:KACSUR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70394
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0394
Mailing Address - Country:US
Mailing Address - Phone:907-455-0250
Mailing Address - Fax:907-455-0250
Practice Address - Street 1:535 2ND AVE
Practice Address - Street 2:SUITE 207B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4728
Practice Address - Country:US
Practice Address - Phone:907-455-0250
Practice Address - Fax:907-455-0250
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical