Provider Demographics
NPI:1821761586
Name:LUCKMAN, RACHEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:LUCKMAN
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 1:630 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1827
Mailing Address - Country:US
Mailing Address - Phone:516-507-8255
Mailing Address - Fax:
Practice Address - Street 1:630 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1827
Practice Address - Country:US
Practice Address - Phone:516-507-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024427103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty