Provider Demographics
NPI:1225712789
Name:VERONNEAU, RACHEL LUCILLE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LUCILLE
Last Name:VERONNEAU
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 1:640 MENLO AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4712
Mailing Address - Country:US
Mailing Address - Phone:650-303-0074
Mailing Address - Fax:
Practice Address - Street 1:640 MENLO AVE STE 9
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4712
Practice Address - Country:US
Practice Address - Phone:650-303-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist