Provider Demographics
NPI:1437206083
Name:RAIZMAN, LUCY S (MSW)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:S
Last Name:RAIZMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FERNBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1508
Mailing Address - Country:US
Mailing Address - Phone:215-345-8454
Mailing Address - Fax:215-628-4622
Practice Address - Street 1:921-A NORTH BETHLEHEM PIKE
Practice Address - Street 2:SUITE 205
Practice Address - City:SPRINGHOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1409
Practice Address - Country:US
Practice Address - Phone:215-345-8454
Practice Address - Fax:215-628-4622
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW007735L1041C0700X
PAMF000131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA535999Medicare ID - Type Unspecified