Provider Demographics
NPI:1699974782
Name:FOGELBERG, RACHEL BERENT (LMSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:BERENT
Last Name:FOGELBERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:BERENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2026 WINSTED BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6040
Mailing Address - Country:US
Mailing Address - Phone:734-678-0436
Mailing Address - Fax:
Practice Address - Street 1:2026 WINSTED BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6040
Practice Address - Country:US
Practice Address - Phone:734-678-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084583104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker