Provider Demographics
NPI:1275535023
Name:RAAB, BONNI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNI
Middle Name:
Last Name:RAAB
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 1:978 ROUTE 45
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3565
Mailing Address - Country:US
Mailing Address - Phone:845-364-9422
Mailing Address - Fax:845-364-9422
Practice Address - Street 1:978 ROUTE 45
Practice Address - Street 2:SUITE 200
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3565
Practice Address - Country:US
Practice Address - Phone:845-364-9422
Practice Address - Fax:845-364-9422
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014543-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY205095OtherUNITED BEHAVIORAL HEALTH
NYDR8999OtherOXFORD
NY7492802OtherGHI & VALUE OPTIONS
NYNG9411Medicare ID - Type UnspecifiedMEDICARE