Provider Demographics
NPI:1396304762
Name:BLACK, RACHEL (LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 PENNSYLVANIA AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004-2582
Mailing Address - Country:US
Mailing Address - Phone:202-998-2089
Mailing Address - Fax:
Practice Address - Street 1:1101 PENNSYLVANIA AVE NW SUITE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004
Practice Address - Country:US
Practice Address - Phone:202-998-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103296104100000X
NY0936171041C0700X
DCLC2000019991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker