Provider Demographics
NPI:1427583012
Name:LACKS, RACHEL STEPHANIE (EDM)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:STEPHANIE
Last Name:LACKS
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:57 W 57TH ST
Mailing Address - Street 2:SUITE 1007
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:212-658-0110
Mailing Address - Fax:646-219-4619
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 1007
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-658-0110
Practice Address - Fax:646-219-4619
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent