Provider Demographics
NPI:1346743069
Name:CARBONNEAU, RACHEL A (LICSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:CARBONNEAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:A
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5125 COUNTY ROAD 101 SUITE 300
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-932-7277
Mailing Address - Fax:952-932-9827
Practice Address - Street 1:5125 COUNTY ROAD 101 SUITE 300
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-932-7277
Practice Address - Fax:952-932-9827
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical