Provider Demographics
NPI:1295442317
Name:CAVICCHIA, RACHELLE (LPC)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:CAVICCHIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:JELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3310
Mailing Address - Country:US
Mailing Address - Phone:610-457-8644
Mailing Address - Fax:
Practice Address - Street 1:210 W FRONT ST STE 210
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3149
Practice Address - Country:US
Practice Address - Phone:484-416-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health