Provider Demographics
NPI:1912001371
Name:MCLEOD-RABCHENUK, JERI JOAN (LICSW CLINICAL SOCIA)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:JOAN
Last Name:MCLEOD-RABCHENUK
Suffix:
Gender:F
Credentials:LICSW CLINICAL SOCIA
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:
Other - Last Name:MCLEOD RABCHENUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW CLINICAL SOCIA
Mailing Address - Street 1:140 COMMONWEALTH AVENUE
Mailing Address - Street 2:STE 202
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-774-6820
Mailing Address - Fax:978-777-4242
Practice Address - Street 1:140 COMMONWEALTH AVENUE
Practice Address - Street 2:STE 202 CATHOLIC CHARITIES
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-774-6820
Practice Address - Fax:978-777-4242
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01278Medicare ID - Type Unspecified