Provider Demographics
NPI:1790787257
Name:BLOGG, RACHEL WHIPPLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:WHIPPLE
Last Name:BLOGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21218 ST. ANDREWS BLVD
Mailing Address - Street 2:PMB 629
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2435
Mailing Address - Country:US
Mailing Address - Phone:754-200-1328
Mailing Address - Fax:754-218-0912
Practice Address - Street 1:6881 N GRANDE DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:754-200-1328
Practice Address - Fax:754-218-0912
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6119104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
E5134AMedicare ID - Type Unspecified