Provider Demographics
NPI:1346975737
Name:RABURN, MICHELLE PRUNEDA (CSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:PRUNEDA
Last Name:RABURN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PRUNEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:601 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3140
Mailing Address - Country:US
Mailing Address - Phone:308-345-4067
Mailing Address - Fax:308-345-3067
Practice Address - Street 1:601 NORRIS AVE
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3140
Practice Address - Country:US
Practice Address - Phone:308-345-4067
Practice Address - Fax:308-345-3067
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3124104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty