Provider Demographics
NPI:1598116923
Name:LAX, RACHAEL ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:LAX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 WIMBLEDON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-4728
Mailing Address - Country:US
Mailing Address - Phone:585-530-9484
Mailing Address - Fax:
Practice Address - Street 1:63 PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2415
Practice Address - Country:US
Practice Address - Phone:585-530-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical