Provider Demographics
NPI:1720373780
Name:RABADY, JENNIFER R (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:RABADY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 CASTOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2729
Mailing Address - Country:US
Mailing Address - Phone:215-554-4489
Mailing Address - Fax:267-350-4887
Practice Address - Street 1:8220 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2729
Practice Address - Country:US
Practice Address - Phone:215-554-4489
Practice Address - Fax:267-350-4887
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1041C0700X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health