Provider Demographics
NPI:1821002890
Name:COONEY, RACHEL N (LICSW SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:N
Last Name:COONEY
Suffix:
Gender:F
Credentials:LICSW SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840
Mailing Address - Country:US
Mailing Address - Phone:401-849-9114
Mailing Address - Fax:401-789-3748
Practice Address - Street 1:24 SALT POND ROAD
Practice Address - Street 2:STE D4
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-789-3694
Practice Address - Fax:401-789-3748
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW00287104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411528OtherRI BLUE CHIP
RI272722OtherRI BLUE CROSS
RIRC51566Medicaid