Provider Demographics
NPI:1710052345
Name:SAKS, RACHEL (PSYD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SAKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 VIEWRIDGE AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1658
Mailing Address - Country:US
Mailing Address - Phone:800-257-8715
Mailing Address - Fax:
Practice Address - Street 1:528 S 45TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3914
Practice Address - Country:US
Practice Address - Phone:215-266-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1783225OtherBCBS
PA1015189680001Medicaid
PA1783225OtherBCBS