Provider Demographics
NPI:1912366782
Name:RACHEL A. LACKOVIC, LCSW LLC
Entity Type:Organization
Organization Name:RACHEL A. LACKOVIC, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-873-5206
Mailing Address - Street 1:807 W 26TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-3205
Mailing Address - Country:US
Mailing Address - Phone:814-873-5206
Mailing Address - Fax:814-461-0235
Practice Address - Street 1:807 W 26TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-3205
Practice Address - Country:US
Practice Address - Phone:814-873-5206
Practice Address - Fax:814-461-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0172501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty