Provider Demographics
NPI:1336508217
Name:RACHEL LIVELY INCORPORATED
Entity Type:Organization
Organization Name:RACHEL LIVELY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-221-4844
Mailing Address - Street 1:25 MARKET ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3999
Mailing Address - Country:US
Mailing Address - Phone:508-221-4844
Mailing Address - Fax:
Practice Address - Street 1:25 MARKET ST
Practice Address - Street 2:SUITE 14
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3999
Practice Address - Country:US
Practice Address - Phone:508-221-4844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty