Provider Demographics
NPI:1366487068
Name:RAAB, INGRID E (PSYD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:E
Last Name:RAAB
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 1:10 W RIDING ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6931
Mailing Address - Country:US
Mailing Address - Phone:781-237-0909
Mailing Address - Fax:781-772-1152
Practice Address - Street 1:572 WASHINGTON ST
Practice Address - Street 2:SUITE 1 -3
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6418
Practice Address - Country:US
Practice Address - Phone:781-237-0909
Practice Address - Fax:781-772-1152
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7342103TC0700X, 103TB0200X, 103TC2200X, 103T00000X, 106H00000X, 103TE1100X, 103TA0400X, 103TA0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0527025Medicaid
MA7529313OtherA ETNAUS HEALTHCARE
MAW50495Medicare ID - Type UnspecifiedPSYCHOLOGIST