Provider Demographics
NPI:1023592748
Name:JOHN, RACHEL SONIA (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:SONIA
Last Name:JOHN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 THOMAS BURGIN PKWY APT 419
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7654
Mailing Address - Country:US
Mailing Address - Phone:215-776-1726
Mailing Address - Fax:
Practice Address - Street 1:625 THOMAS BURGIN PKWY APT 419
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7654
Practice Address - Country:US
Practice Address - Phone:215-776-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120618-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical