Provider Demographics
NPI:1720210131
Name:HALL, RACHAEL EVE (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:EVE
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SETAUKET TRL
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2256
Mailing Address - Country:US
Mailing Address - Phone:631-566-7392
Mailing Address - Fax:
Practice Address - Street 1:755 WAVERLY AVE
Practice Address - Street 2:SUITE 204 A
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1190
Practice Address - Country:US
Practice Address - Phone:631-566-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079664-1104100000X
NY081720-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker