Provider Demographics
NPI:1255620449
Name:LACKOVIC, RACHEL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:LACKOVIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 WEST 26TH STREET
Mailing Address - Street 2:BOX 14
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508
Mailing Address - Country:US
Mailing Address - Phone:814-873-5206
Mailing Address - Fax:844-556-4667
Practice Address - Street 1:1946 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1162
Practice Address - Country:US
Practice Address - Phone:814-873-5206
Practice Address - Fax:844-556-4667
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0172501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical