Provider Demographics
NPI:1396361168
Name:KREPACK, RACHEL VICTORIA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:VICTORIA
Last Name:KREPACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N ROXBURY DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3017
Mailing Address - Country:US
Mailing Address - Phone:310-409-5959
Mailing Address - Fax:
Practice Address - Street 1:12501 CHANDLER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1955
Practice Address - Country:US
Practice Address - Phone:818-821-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical