Provider Demographics
NPI:1275668444
Name:RAQUET-SAFFORD, DEBRA N (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:N
Last Name:RAQUET-SAFFORD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP HARBOR
Mailing Address - State:IL
Mailing Address - Zip Code:60096-1744
Mailing Address - Country:US
Mailing Address - Phone:847-322-4109
Mailing Address - Fax:
Practice Address - Street 1:1100 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WINTHROP HARBOR
Practice Address - State:IL
Practice Address - Zip Code:60096-1744
Practice Address - Country:US
Practice Address - Phone:847-322-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490060251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical