Provider Demographics
NPI:1104369727
Name:SAENZ, RAUL
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:SAENZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 EAST ST UNIT C2
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1950
Mailing Address - Country:US
Mailing Address - Phone:617-445-1123
Mailing Address - Fax:857-547-1186
Practice Address - Street 1:365 EAST ST UNIT C2
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1950
Practice Address - Country:US
Practice Address - Phone:617-445-1123
Practice Address - Fax:857-547-1186
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12201101YA0400X
MA12780101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1104369727Medicaid