Provider Demographics
NPI:1134699648
Name:MASELLA, RACHEL DAWN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAWN
Last Name:MASELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 JERONIMO CT
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-6918
Mailing Address - Country:US
Mailing Address - Phone:845-401-3334
Mailing Address - Fax:
Practice Address - Street 1:26 JERONIMO CT
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-6918
Practice Address - Country:US
Practice Address - Phone:845-401-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0183641041C0700X
NY081364-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical