Provider Demographics
NPI:1063776490
Name:DALTRY, RACHEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:DALTRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 FOULK RD STE 204
Mailing Address - Street 2:FOULKSTONE PLAZA
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2755
Mailing Address - Country:US
Mailing Address - Phone:302-468-6814
Mailing Address - Fax:
Practice Address - Street 1:1409 FOULK RD STE 204
Practice Address - Street 2:FOULKSTONE PLAZA
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2755
Practice Address - Country:US
Practice Address - Phone:302-468-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000903103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical