Provider Demographics
NPI:1174138499
Name:FEDDOR, RACHEL THERESA
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:THERESA
Last Name:FEDDOR
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 1:1970 COMMONWEALTH AVE APT 48
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5820
Mailing Address - Country:US
Mailing Address - Phone:630-544-8399
Mailing Address - Fax:
Practice Address - Street 1:1970 COMMONWEALTH AVE APT 48
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5820
Practice Address - Country:US
Practice Address - Phone:630-544-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health