Provider Demographics
NPI:1568869428
Name:PRENTICE, RACHEL (MA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3301
Mailing Address - Country:US
Mailing Address - Phone:408-826-4828
Mailing Address - Fax:
Practice Address - Street 1:474 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3301
Practice Address - Country:US
Practice Address - Phone:408-826-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst