Provider Demographics
NPI:1134915804
Name:RACHEL, MALLORY (EDS, MED, PPS)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:RACHEL
Suffix:
Gender:
Credentials:EDS, MED, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 E JACK LONDON BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1855
Mailing Address - Country:US
Mailing Address - Phone:925-960-2937
Mailing Address - Fax:
Practice Address - Street 1:685 E JACK LONDON BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-1855
Practice Address - Country:US
Practice Address - Phone:925-960-2937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool