Provider Demographics
NPI:1932391133
Name:THOMAS, RACHEL LEE (PCNS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HADLEY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1012
Mailing Address - Country:US
Mailing Address - Phone:888-722-4358
Mailing Address - Fax:888-722-4358
Practice Address - Street 1:6 HADLEY ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1012
Practice Address - Country:US
Practice Address - Phone:888-722-4358
Practice Address - Fax:888-722-4358
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41299980364SP0809X
MARN2312265364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty