Provider Demographics
NPI:1912597097
Name:CORWIN, RACHEL MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARIE
Last Name:CORWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 BEELARD DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5853
Mailing Address - Country:US
Mailing Address - Phone:708-420-0943
Mailing Address - Fax:
Practice Address - Street 1:327 COLLEGE ST STE 206
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3484
Practice Address - Country:US
Practice Address - Phone:916-288-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty