Provider Demographics
NPI:1720784069
Name:JAMISON, RACHEL (LCSW, MED)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LCSW, MED
Other - Prefix:
Other - First Name:RJ
Other - Middle Name:
Other - Last Name:JAMISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, MED
Mailing Address - Street 1:217 FARABEE DR N
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5910
Mailing Address - Country:US
Mailing Address - Phone:765-250-5416
Mailing Address - Fax:
Practice Address - Street 1:217 FARABEE DR N
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5910
Practice Address - Country:US
Practice Address - Phone:765-250-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010192A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical