Provider Demographics
NPI:1316451040
Name:RACHAEL HASKELL PHD RESOLUTION TODAY
Entity type:Organization
Organization Name:RACHAEL HASKELL PHD RESOLUTION TODAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-698-2543
Mailing Address - Street 1:11800 DR MARTIN LUTHER KING JR ST N APT 1101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1600
Mailing Address - Country:US
Mailing Address - Phone:727-698-2543
Mailing Address - Fax:
Practice Address - Street 1:6177 SUN BLVD APT 404
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-1146
Practice Address - Country:US
Practice Address - Phone:172-769-8254
Practice Address - Fax:727-698-2543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1366404915OtherNPI