Provider Demographics
NPI:1952743486
Name:MATHIAK, RACHAEL (LCSW, LMSW, LICSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MATHIAK
Suffix:
Gender:F
Credentials:LCSW, LMSW, LICSW
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:MULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 150751
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49515-0751
Mailing Address - Country:US
Mailing Address - Phone:616-322-1858
Mailing Address - Fax:
Practice Address - Street 1:3280 E BELTLINE CT NE STE 100-200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9494
Practice Address - Country:US
Practice Address - Phone:616-330-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA738231041C0700X
MA1245541041C0700X
MI68011100651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical