Provider Demographics
NPI:1275758708
Name:RACHMAN, JENNIFER SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:RACHMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WALES PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1640
Mailing Address - Country:US
Mailing Address - Phone:718-448-6609
Mailing Address - Fax:
Practice Address - Street 1:6581 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3830
Practice Address - Country:US
Practice Address - Phone:718-984-4589
Practice Address - Fax:718-984-4753
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075369-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical