Provider Demographics
NPI:1699257543
Name:DEYONG, RACHEL (MSED, PHD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DEYONG
Suffix:
Gender:F
Credentials:MSED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MARTINE AVE APT 1102
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-4022
Mailing Address - Country:US
Mailing Address - Phone:201-906-9233
Mailing Address - Fax:
Practice Address - Street 1:410 E 92ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6881
Practice Address - Country:US
Practice Address - Phone:212-831-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool