Provider Demographics
NPI:1902813538
Name:RIVIDELLI, RACHAEL M (LICSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:M
Last Name:RIVIDELLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PLEASANT ST APT 8
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9789
Mailing Address - Country:US
Mailing Address - Phone:413-427-1002
Mailing Address - Fax:
Practice Address - Street 1:55 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2546
Practice Address - Country:US
Practice Address - Phone:413-584-6855
Practice Address - Fax:413-585-1355
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10214961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS61776Medicare UPIN
MAP20993Medicare PIN