Provider Demographics
NPI:1497179873
Name:RAAEN, GRETA (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:GRETA
Middle Name:
Last Name:RAAEN
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WEST ST STE 3D
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-4400
Mailing Address - Country:US
Mailing Address - Phone:845-204-4333
Mailing Address - Fax:
Practice Address - Street 1:154 WEST ST STE 3D
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4400
Practice Address - Country:US
Practice Address - Phone:860-893-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002245101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty