Provider Demographics
NPI:1083180640
Name:PETERMAN, RAKAIYA L (LSW)
Entity Type:Individual
Prefix:
First Name:RAKAIYA
Middle Name:L
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 MARKET ST STE 2
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6003
Mailing Address - Country:US
Mailing Address - Phone:330-793-2487
Mailing Address - Fax:330-793-9372
Practice Address - Street 1:7620 MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6003
Practice Address - Country:US
Practice Address - Phone:330-793-2487
Practice Address - Fax:330-793-9372
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802943101YP2500X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional