Provider Demographics
NPI:1205226123
Name:RADJEWSKI, RACHEL N (LSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:N
Last Name:RADJEWSKI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:N
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:4880 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-2010
Mailing Address - Country:US
Mailing Address - Phone:313-846-6030
Mailing Address - Fax:
Practice Address - Street 1:4880 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2010
Practice Address - Country:US
Practice Address - Phone:313-846-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010977621041C0700X
CO00099205191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical