Provider Demographics
NPI: | 1518471267 |
---|---|
Name: | CILIBERTI, RACHEL |
Entity Type: | Individual |
Prefix: | |
First Name: | RACHEL |
Middle Name: | |
Last Name: | CILIBERTI |
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: | 1716 HARFORD RD STE 204 |
Mailing Address - Street 2: | |
Mailing Address - City: | FALLSTON |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21047-2699 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-877-7207 |
Mailing Address - Fax: | 410-877-7224 |
Practice Address - Street 1: | 1716 HARFORD RD STE 204 |
Practice Address - Street 2: | |
Practice Address - City: | FALLSTON |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21047-2699 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-877-7207 |
Practice Address - Fax: | 410-877-7224 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-11-16 |
Last Update Date: | 2017-11-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 16931 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 221275 | Other | COMPSYCH |
MD | 89090 | Other | CIGNA BEHAVIORAL HEALTH |
MD | 2226337 | Other | AETNA HEALTH MGMT LLC |
MD | KC83 | Other | CAREFIRST BLUE CROSS BLUE SHIELD |
MD | T460 | Other | BLUE CHOICE |