Provider Demographics
NPI:1205198801
Name:RACCA, CHRISTINE E (MS ED, SDA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:RACCA
Suffix:
Gender:F
Credentials:MS ED, SDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SILAS WOODS RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3052
Mailing Address - Country:US
Mailing Address - Phone:631-580-4005
Mailing Address - Fax:631-471-1954
Practice Address - Street 1:19 SILAS WOODS RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3052
Practice Address - Country:US
Practice Address - Phone:631-580-4005
Practice Address - Fax:631-471-1954
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1044421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist