Provider Demographics
NPI:1689085326
Name:KIRK, RACHAEL (TEACHER SPECIAL EDU)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:TEACHER SPECIAL EDU
Other - Prefix:MISS
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:MAHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TEACHER SPECIAL EDU
Mailing Address - Street 1:28 VAN BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3843
Mailing Address - Country:US
Mailing Address - Phone:631-615-6121
Mailing Address - Fax:
Practice Address - Street 1:35 EASON DR
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-3111
Practice Address - Country:US
Practice Address - Phone:631-345-6501
Practice Address - Fax:718-307-5547
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY810179131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist