Provider Demographics
NPI:1215763891
Name:STILLWELL, RAECHEL E
Entity type:Individual
Prefix:MRS
First Name:RAECHEL
Middle Name:E
Last Name:STILLWELL
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 1:781 N JUDSON ST STE 130
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2507
Mailing Address - Country:US
Mailing Address - Phone:215-282-3004
Mailing Address - Fax:215-282-8597
Practice Address - Street 1:717 BETHLEHEM PIKE STE 340
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-8118
Practice Address - Country:US
Practice Address - Phone:215-282-3004
Practice Address - Fax:215-282-8597
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional