Basic Information
| Provider Information | |||||||||
| NPI: | 1598133852 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUBERMAN | ||||||||
| FirstName: | RACHEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 MAITLAND CENTER PKWY STE 240 | ||||||||
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| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075746568 | ||||||||
| FaxNumber: | 4075743091 | ||||||||
| Practice Location | |||||||||
| Address1: | 644 FERGUSON DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328051023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075744629 | ||||||||
| FaxNumber: | 4075743091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.