Provider Demographics
NPI:1912144544
Name:WAXMAN, RACHEL (PHD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CEDAR LN FL 2
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1709
Mailing Address - Country:US
Mailing Address - Phone:917-328-5068
Mailing Address - Fax:
Practice Address - Street 1:416 CEDAR LN FL 2
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1709
Practice Address - Country:US
Practice Address - Phone:917-328-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00617100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist