Provider Demographics
NPI:1255483095
Name:PAKENHAM, RACHEL D (MSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:D
Last Name:PAKENHAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:FREDERIKSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00841-0661
Mailing Address - Country:US
Mailing Address - Phone:340-772-5209
Mailing Address - Fax:340-713-3208
Practice Address - Street 1:79 A LA GRANGE
Practice Address - Street 2:FLEMING CIRCLE
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00841-0661
Practice Address - Country:US
Practice Address - Phone:340-772-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0025171041C0700X
VI2-2050103-20081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical