Provider Demographics
NPI:1427394923
Name:BOODHAN, RACHEAL KHATISHA
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:KHATISHA
Last Name:BOODHAN
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 1:7 SYLVIA CT
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1217
Mailing Address - Country:US
Mailing Address - Phone:617-943-2066
Mailing Address - Fax:
Practice Address - Street 1:7 SYLVIA CT
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1217
Practice Address - Country:US
Practice Address - Phone:617-943-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker