Provider Demographics
NPI:1417779778
Name:PASCUCCI, RACHAEL A
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:PASCUCCI
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 1:711 SHORE RD APT 2E
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4707
Mailing Address - Country:US
Mailing Address - Phone:631-786-7628
Mailing Address - Fax:
Practice Address - Street 1:175 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-7508
Practice Address - Country:US
Practice Address - Phone:959-210-6800
Practice Address - Fax:959-210-6634
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111137-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker