Provider Demographics
NPI:1902329071
Name:RAKAY, JENNIFER MORGAN CHAMBERS (MA, LPC, BC-DMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER MORGAN
Middle Name:CHAMBERS
Last Name:RAKAY
Suffix:
Gender:F
Credentials:MA, LPC, BC-DMT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:RAKAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, BC-DMT
Mailing Address - Street 1:575 FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2449
Mailing Address - Country:US
Mailing Address - Phone:304-389-1500
Mailing Address - Fax:
Practice Address - Street 1:575 FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2449
Practice Address - Country:US
Practice Address - Phone:679-084-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1219225600000X
PAPC009044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist