Provider Demographics
NPI:1548010598
Name:SMALL, RACHEL LAUREN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAUREN
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 TIMBERCREST DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3716
Mailing Address - Country:US
Mailing Address - Phone:856-981-5427
Mailing Address - Fax:
Practice Address - Street 1:26 TIMBERCREST DR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3716
Practice Address - Country:US
Practice Address - Phone:185-698-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician