Provider Demographics
NPI:1902576044
Name:PADILLA, RACHEL QUINN (MSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:QUINN
Last Name:PADILLA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 ELDERFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3426
Mailing Address - Country:US
Mailing Address - Phone:805-305-0912
Mailing Address - Fax:
Practice Address - Street 1:1041 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2712
Practice Address - Country:US
Practice Address - Phone:805-305-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW162581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical