Provider Demographics
NPI:1851905210
Name:STOUCK, RACHEL JOY (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:JOY
Last Name:STOUCK
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 1:14 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2904
Mailing Address - Country:US
Mailing Address - Phone:301-802-2414
Mailing Address - Fax:
Practice Address - Street 1:222 FORBES RD STE 207
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2720
Practice Address - Country:US
Practice Address - Phone:781-298-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0002250981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical