Basic Information
Provider Information | |||||||||
NPI: | 1699220574 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GILBERT | ||||||||
FirstName: | RACHEL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSYD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WESTERHOFF | ||||||||
OtherFirstName: | RACHEL | ||||||||
OtherMiddleName: | E | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PSYD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 84 SKYLINE DR | ||||||||
Address2: |   | ||||||||
City: | SALEM | ||||||||
State: | CT | ||||||||
PostalCode: | 064204107 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2097686049 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 331 WETHERSFIELD AVE | ||||||||
Address2: |   | ||||||||
City: | HARTFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 061141420 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8602364511 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/19/2016 | ||||||||
LastUpdateDate: | 08/13/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/13/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   | CA | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 103TC0700X | 003829 | CT | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.