Provider Demographics
NPI:1316591985
Name:MANEJWALA, RAISA ALIF (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAISA
Middle Name:ALIF
Last Name:MANEJWALA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 BAY RIDGE AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-2834
Mailing Address - Country:US
Mailing Address - Phone:443-281-9430
Mailing Address - Fax:443-782-2446
Practice Address - Street 1:1819 BAY RIDGE AVE STE 190
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-2834
Practice Address - Country:US
Practice Address - Phone:443-281-9430
Practice Address - Fax:443-782-2446
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06189103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty