Provider Demographics
NPI:1912033028
Name:AVERY, RACHEL ROBB (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ROBB
Last Name:AVERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ROBB
Other - Last Name:TATGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:9 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2015
Mailing Address - Country:US
Mailing Address - Phone:207-775-2131
Mailing Address - Fax:207-829-5286
Practice Address - Street 1:9 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2015
Practice Address - Country:US
Practice Address - Phone:207-775-2131
Practice Address - Fax:207-829-5286
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical