Basic Information
| Provider Information | |||||||||
| NPI: | 1912001371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEOD-RABCHENUK | ||||||||
| FirstName: | JERI | ||||||||
| MiddleName: | JOAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LICSW CLINICAL SOCIA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCLEOD RABCHENUK | ||||||||
| OtherFirstName: | JERI | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LICSW CLINICAL SOCIA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 140 COMMONWEALTH AVENUE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787746820 | ||||||||
| FaxNumber: | 9787774242 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 COMMONWEALTH AVENUE | ||||||||
| Address2: | STE 202 CATHOLIC CHARITIES | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787746820 | ||||||||
| FaxNumber: | 9787774242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 101276 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.