Provider Demographics
NPI:1457122087
Name:KOLODZIEJCZAK, RACHAEL LEIGH (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:LEIGH
Last Name:KOLODZIEJCZAK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3017
Mailing Address - Country:US
Mailing Address - Phone:609-560-3712
Mailing Address - Fax:
Practice Address - Street 1:409 LINDEN ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3017
Practice Address - Country:US
Practice Address - Phone:609-560-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14988300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health