Provider Demographics
NPI:1689493520
Name:SCULLY, RACHEL NATALIE (LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NATALIE
Last Name:SCULLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2842
Mailing Address - Country:US
Mailing Address - Phone:860-222-7828
Mailing Address - Fax:
Practice Address - Street 1:54 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2842
Practice Address - Country:US
Practice Address - Phone:860-222-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7847101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health