Provider Demographics
NPI:1164707634
Name:REICHERT, RACHEL E (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:E
Last Name:REICHERT
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 1:220 OLD SNAKE HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-1783
Mailing Address - Country:US
Mailing Address - Phone:401-487-5522
Mailing Address - Fax:
Practice Address - Street 1:220 OLD SNAKE HILL ROAD
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-1783
Practice Address - Country:US
Practice Address - Phone:401-487-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1-09-5274103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst