Provider Demographics
NPI:1790244945
Name:ALBONE-BUSHNELL, RACHEL ANNE (EDD, CSP, RBT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:ALBONE-BUSHNELL
Suffix:
Gender:F
Credentials:EDD, CSP, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CAMP AVE APT 11D
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-1840
Mailing Address - Country:US
Mailing Address - Phone:914-374-2601
Mailing Address - Fax:
Practice Address - Street 1:85 CAMP AVE APT 11D
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-1840
Practice Address - Country:US
Practice Address - Phone:914-374-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool