Provider Demographics
NPI:1447012612
Name:PRENDERGAST, RACHEL (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 CORTONA DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8609
Mailing Address - Country:US
Mailing Address - Phone:727-656-2502
Mailing Address - Fax:
Practice Address - Street 1:3018 CORTONA DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8609
Practice Address - Country:US
Practice Address - Phone:727-656-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10925949171400000X
FLSW115821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171400000XOther Service ProvidersHealth & Wellness Coach