Provider Demographics
NPI:1356322069
Name:GRAHN, RACHEL LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYNN
Last Name:GRAHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:HERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:14 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-5701
Mailing Address - Country:US
Mailing Address - Phone:516-477-1484
Mailing Address - Fax:845-471-2223
Practice Address - Street 1:1133 ROUTE 55 STE 11
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5052
Practice Address - Country:US
Practice Address - Phone:516-477-1484
Practice Address - Fax:845-471-2223
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064294-1104100000X
NY075557-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker