Provider Demographics
NPI:1851456149
Name:PREWETT, RACHAEL BLAIRE (LPC, LCSW, RPT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:BLAIRE
Last Name:PREWETT
Suffix:
Gender:F
Credentials:LPC, LCSW, RPT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4156 AVERY LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3401
Mailing Address - Country:US
Mailing Address - Phone:314-791-2627
Mailing Address - Fax:
Practice Address - Street 1:4156 AVERY LN
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3401
Practice Address - Country:US
Practice Address - Phone:314-791-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004037092101YP2500X
IL149.0218911041C0700X
MO20100075081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499452902Medicaid