Provider Demographics
NPI:1245582709
Name:RAGHUVIR, VEENA (LCSW)
Entity Type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:RAGHUVIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 HOPMEADOW ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2299
Mailing Address - Country:US
Mailing Address - Phone:203-535-9696
Mailing Address - Fax:
Practice Address - Street 1:760 HOPMEADOW ST STE 204
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2299
Practice Address - Country:US
Practice Address - Phone:203-535-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025219Medicaid