Provider Demographics
NPI:1689275885
Name:SCIARRETTA, RACHAEL
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:SCIARRETTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 S ORANGE AVE # 353
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4543
Mailing Address - Country:US
Mailing Address - Phone:540-922-1110
Mailing Address - Fax:775-392-1245
Practice Address - Street 1:2805 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4512
Practice Address - Country:US
Practice Address - Phone:703-870-3880
Practice Address - Fax:755-392-1245
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002953103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017593240001Medicaid