Provider Demographics
NPI:1356671960
Name:KO, RACHEL (MASTERS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 STUBBLE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-2068
Mailing Address - Country:US
Mailing Address - Phone:401-699-2234
Mailing Address - Fax:
Practice Address - Street 1:186 STUBBLE BROOK RD
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-2068
Practice Address - Country:US
Practice Address - Phone:401-699-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00145106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid