Provider Demographics
NPI:1093045965
Name:RAICH, JEFFREY (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:RAICH
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2506
Mailing Address - Country:US
Mailing Address - Phone:651-408-5069
Mailing Address - Fax:855-407-1613
Practice Address - Street 1:871 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2506
Practice Address - Country:US
Practice Address - Phone:651-408-5069
Practice Address - Fax:855-407-1613
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN184831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical