Provider Demographics
NPI:1770868143
Name:FAIELLA, RACHEL (LMSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FAIELLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2636
Mailing Address - Country:US
Mailing Address - Phone:845-838-6900
Mailing Address - Fax:
Practice Address - Street 1:101 MATTEAWAN RD
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1571
Practice Address - Country:US
Practice Address - Phone:845-838-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0759871041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool