Provider Demographics
NPI:1669079737
Name:RYBAK, RACHAEL ELAINE
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ELAINE
Last Name:RYBAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5918
Mailing Address - Country:US
Mailing Address - Phone:301-644-5000
Mailing Address - Fax:
Practice Address - Street 1:5525 BALLENGER CREEK PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7015
Practice Address - Country:US
Practice Address - Phone:410-926-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health