Provider Demographics
NPI:1588164073
Name:RANA-RUBY, RACHAEL LAUREN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:LAUREN
Last Name:RANA-RUBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LAUREN
Other - Last Name:RUBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1850 SPRING CITY HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-5951
Mailing Address - Country:US
Mailing Address - Phone:865-203-8048
Mailing Address - Fax:
Practice Address - Street 1:2305 N GATEWAY AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8709
Practice Address - Country:US
Practice Address - Phone:865-882-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6226104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker