Provider Demographics
NPI:1144706607
Name:MACK, RHEA KAUFMAN (LICSW)
Entity type:Individual
Prefix:
First Name:RHEA
Middle Name:KAUFMAN
Last Name:MACK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3160
Mailing Address - Country:US
Mailing Address - Phone:413-582-5254
Mailing Address - Fax:413-582-5229
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3160
Practice Address - Country:US
Practice Address - Phone:413-582-5254
Practice Address - Fax:413-582-5229
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120518104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker