Basic Information
Provider Information
NPI: 1295386043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DABKOWSKI
FirstName: RACHAEL
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SMITH
OtherFirstName: RACHAEL
OtherMiddleName:  
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential: M.A.
OtherLastNameType: 1
Mailing Information
Address1: 340 S BROADWAY ST
Address2:  
City: AKRON
State: OH
PostalCode: 443081529
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 340 S BROADWAY ST
Address2:  
City: AKRON
State: OH
PostalCode: 443081529
CountryCode: US
TelephoneNumber: 3302533100
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2019
LastUpdateDate: 09/24/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  Y Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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