Basic Information
| Provider Information | |||||||||
| NPI: | 1619399854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDGERLE | ||||||||
| FirstName: | RACHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22032 ALAMOGORDO RD | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913502166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616707140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28245 AVE CROCKER | ||||||||
| Address2: | STE 220 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612547086 | ||||||||
| FaxNumber: | 6612547108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2014 | ||||||||
| LastUpdateDate: | 01/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.