Provider Demographics
NPI:1154450468
Name:RASKIN, PAMELA ALESSANDRA (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ALESSANDRA
Last Name:RASKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2412
Mailing Address - Country:US
Mailing Address - Phone:617-876-2482
Mailing Address - Fax:
Practice Address - Street 1:985 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5434
Practice Address - Country:US
Practice Address - Phone:781-848-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARA WO2-691OtherPROVIDER NUMBER