1770799140 NPI number — MS. RACHAEL MARIE TYLER LCSW ACS

Table of content: MS. RACHAEL MARIE TYLER LCSW ACS (NPI 1770799140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770799140 NPI number — MS. RACHAEL MARIE TYLER LCSW ACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYLER
Provider First Name:
RACHAEL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW ACS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770799140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 787
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLSWORTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04605-0787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-667-0909
Provider Business Mailing Address Fax Number:
207-667-6348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 STILLWATER AVENUE
Provider Second Line Business Practice Location Address:
UNIVERSITY MALL
Provider Business Practice Location Address City Name:
ORONO
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-827-4150
Provider Business Practice Location Address Fax Number:
207-827-4180
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  LC9115 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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