Provider Demographics
NPI:1538542691
Name:STEPHEN, RACHEL MARIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:MARIA
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W JOHNSON AVE UNIT 310
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-4505
Mailing Address - Country:US
Mailing Address - Phone:203-718-6087
Mailing Address - Fax:
Practice Address - Street 1:1309 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1758
Practice Address - Country:US
Practice Address - Phone:203-597-9044
Practice Address - Fax:203-597-8637
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical